Medicare & Medicaid 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.

Provider Contracting

Credentialing

Privileging

Enrollment

Provider Analytics

Understanding regulations is vital.

TractManager’s Medicare/Medicaid Enrollment Specialists understand all the different states’ enrollment regulations. Our goal is to ensure 100-percent participation status with every payer for each provider at every location where they practice.

Ease the Burden of Medicare and Medicaid Enrollment

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

TractManager’s expert Medicare and Medicaid enrollment specialists conduct the necessary research to get providers and groups enrolled as quickly as possible so they can start billing. Moreover, we’ll ensure that once you’re enrolled, you stay that way.

Medicare

From Part A and Part B, and PECOS versus paper, through DME and Telehealth, realizing who and how to enroll with CMS can get complex and cumbersome very quickly. Once providers are enrolled, mandatory revalidation must be managed diligently to avoid a potentially catastrophic loss of revenue.

Medicaid

Medicaid is managed on a state-by-state basis. This requires that special attention be paid to providers practicing in multiple locations crossing 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.

Understanding the Enrollment Process

Get Started with Par/Non-Par Analysis

Our team of experts initiates a Par/Non-Par analysis against state, federal, and various payer listings to determine whether the provider is not only participating already, but also is accurately profiled. Any identified gaps prompt our team to initiate the enrollment process and take the required corrective action.

Expirables Management

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. Our solution supports all the storage and tracking of your provider data elements and documentation.

Enrollment Status Reporting

Our enrollment solution provides flexible enterprise summary reports that depict real-time statuses (Par, Non-Par, In-Process) and syncs up with in-process gross charges to show the financial impact of delayed enrollments. Once the plan confirms the participating status of a provider, the system is updated accordingly, and the status becomes instantly visible to all system users. Using the versatility of the BI Reporting, regularly scheduled notifications are generated and distributed to ensure patients can be seen and revenue can be realized as quickly as possible.

Compliant 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. Applications must be filled out and vetted, provider signatures obtained where needed, and all necessary supporting documentation attached and submitted to the plan for enrollment. Once submitted, constant and timely follow-up is done to ensure all developments and requests for additional information are handled promptly to avoid delays in participation.

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 your providers and groups, identify those who have not updated or initiated their PECOS accounts, and take appropriate steps to keep their accounts active. We will assist in transitioning all required parties from a paper-based process to the online PECOS, significantly decreasing application processing times.

PECOS Surrogacy Management

Our team manages all PECOS updates for your providers and groups through CMS-recommended surrogacy access. Multi-factor authentication (MFA) requirements and mandatory password updates won’t impede timely enrollment through PECOS with surrogacy in place.

Application Processing

All Group, Provider, or Supplier Medicare and Medicaid applications are prepared, formatted, and submitted to all MAC carriers and state Medicaid organizations through the proper channels.

Quality Assurance

Situational and organizational QA processes ensure that accurate and complete information is sent to the payers. Address standardization in accordance with USPS and claim submissions avoids unnecessary re-work and payment delays.

Application Follow-Up

Rigorous and regular follow-up is conducted on each application, and all status updates are transparently displayed.

PIN Distribution

ID numbers are regularly shared with our clients and key stakeholders, along with downstream Managed Care carriers to initiate and update additional enrollments.

Out-of-State Medicaid Enrollment

With nationwide experience in Medicaid enrollment, TractManager can make sure that those frequent or infrequent visits from out-of-state Medicaid patients get reimbursed.

Medicare and Medicaid Revalidation

Medicare revalidation due dates are automatically updated each month from CMS in TractManager’s system and promptly managed by our enrollment specialists. Medicaid revalidations are monitored and stored in the system by each state’s timeline specifications to ensure proactive management.

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.