Medicaid & Medicare Provider Enrollment

Navigating a critical step in provider onboarding.

Significant time and resources are required to ensure that new and existing providers are properly enrolled with all contracted plans, including Medicare and Medicaid. Avoid mistakes, delays, and lost revenue by doing it right the first time.

Prevent Delays in your Provider Onboarding

It is not uncommon for health systems and provider networks to onboard multiple practitioners at the same time.

Adding to the complexity, health systems and provider networks must also manage re-enrollments for existing providers. Diligent follow-up is required to prevent any unnecessary delays in provider onboarding.

Medicaid is managed on a state-by-state basis. This requires that additional attention be paid to providers practicing in multiple locations that cross state lines. Otherwise, providers who are not properly monitored and enrolled can’t bill for services. In addition to the financial impact, patient satisfaction will suffer if improper enrollment presents issues with patient care.

Ease the Burden of Medicaid and Medicare Enrollment

To ease the burden of Medicaid and Medicare provider enrollment, enlisting the help of an outside partner is an increasingly common practice.

TractManager’s expert Medicare/Medicaid enrollment specialists conduct the necessary research to get providers enrolled as quickly as possible so they can start billing.

Understanding the Enrollment Process

Get Started with Par/Non-Par Analysis

Our team of specialists initiates a Par/Non-Par analysis against state, federal, and various payer listings to determine if the provider is already participating. Any identified gaps prompt our team to initiate the enrollment process.

Primary Source Verification

Embedded with primary source verification technology, our CARE technology allows our specialists to ensure that the most current and accurate information is available. This approach to provider data is critical in developing a source of truth that will be used to populate enrollment applications. Data mapping technology eliminates delays and error-prone manual procedures, further expediting the enrollment process.

Cloud-Based Credentialing and Enrollment Tracking

TractManager’s cloud-based credentialing and enrollment services allow staff to easily track enrollment status through the entire process. This level of transparency and governance ensures timely follow-up and expedites the enrollment process. CARE supports all the storage and tracking of your provider data elements.

Enrollment Status Reporting

The CARE platform provides department-based summary reports that depict current enrollment status (Par, Non-Par, In-Process) and the financial impact of In-Process applications. CARE provides top In-Process Providers and Payers and links Provider Charge Data to each In-Process application. TractManager’s enrollment team will generate regularly scheduled reports detailing enrollments status. Once the plan confirms the participating status of a provider, CARE is updated accordingly, and this is reflected in the reports generated.

We’re Experts in Ensuring a Complaint Enrollment Application Process

After the par/non-par analysis, TractManager moves forward with an initial enrollment application in compliance with state, federal, and payer-specific requirements. In some instances, these can be upwards of 50 pages depending on the plan. Applications must be filled out, provider signatures obtained, and all necessary supporting documentation attached and submitted to the plan for enrollment. Once submitted, the enrollment process can take anywhere from 30 to 180 days, depending on the plan.

If your providers are not enrolled, you won’t get paid.

To be paid by Medicare and Medicaid, a provider needs to be enrolled. When it comes to Medicare and Medicaid services, TractManager submits all the required forms and documentation and then actively follows up with each payer to get your providers enrolled and keep them enrolled with all of their Medicare & Medicaid plans.

PECOS Provider Assessment

Our account management team will assess all your providers, identify which ones have not updated or initiated their PECOS accounts, and take appropriate steps to keep their accounts active.

PECOS Account Management

Our team manages all PECOS updates for your providers.

Enrollment Application Processing

All payer applications are prepared, formatted, and sent to the provider for signatures.

Quality Assurance

Situational and Organizational QA processes ensure that accurate and complete information is sent to the payers.

Application Follow-Up

Rigorous and regular follow-up is conducted on each application.

PIN Compilation

Received PINs are regularly shared with our clients and key stakeholders.

Out-of-State Medicaid Enrollment

TractManager can make sure that those frequent or infrequent visits from out-of-state Medicaid patients get reimbursed.

Medicare Revalidation

Medicare revalidation due dates are automatically updated each month in TractManager’s system and promptly managed by our enrollment specialists.

Our Solutions Automate and Streamline Your Provider Management Processes.

Learn how our integrated MediTract CLM, Provider Onboarding, and Provider Analytics capabilities deliver measurable results to your healthcare organization.