Maximize Growth with Medicaid Credentialing

Medicaid is a government-funded healthcare program providing medical assistance to individuals and families with low incomes in the United States. Under this healthcare program, with over 70 million people enrolled, it is crucial for healthcare providers looking to expand their patient base to become credentialed with Medicaid. Credentialing with Medicaid opens numerous growth opportunities for healthcare providers as it authorizes them to attract more patients to provide care according to the established healthcare standards.

In this comprehensive blog, we will discuss the provider credentialing process, types of credentialing, and its importance for healthcare providers.

What Is Credentialing for Providers?

Since 1000 BC, healthcare provider credentialing has been in practice, but it has largely evolved ever since. There are a few important steps when it comes to the credentialing process which includes verifying the skills of a practitioner, qualifications, and experience, authorizing him to deliver healthcare services in his healthcare network. You might have heard people often asking what it means to get credentialed.

The answer is simple! Credentialed practitioners are most likely to get paid by insurance companies for the services they provide to Medicaid beneficiaries. Therefore, healthcare providers must get licensed to practice care.

Benefits Of Being Credentialed

Being credentialed means you can expand your patient base by serving a wider range of patients; assured reimbursement from Medicaid patients, and enhanced professional credibility as a Medicaid-approved healthcare provider.

Here is a simplified procedure to check the competency of a healthcare physician through the following requirements of Medicaid credentialing:

• Complete professional history
• Complete qualification & transcripts
• Board certification, medical license, & DEA registration
• Up-to-date personal health history & immunization records
• Proof of continuous malpractice coverage
• Personal and professional references

What Are the Three Main Types of Credentialing

Credentialing with Medicaid has three main types, namely:

• Initial Credentialing
• Re-credentialing
• Provisional Credentialing

Now it is your choice to select the one, depending on your practice and career type.

Let’s discuss each one in detail to figure out your credentialing needs.

Initial Credentialing

Initial credentialing is for those who are just at the start of their professional career in the healthcare industry. It includes verifying the qualifications and backgrounds of the new professionals.

Re-credentialing

The re-credentialing process involves the verification of the work history and qualification of the physician. It is done to ensure he meets the necessary healthcare standards and his care quality is up to date.

Provisional Credentialing

Those physicians who are new to a healthcare network are provided provisional credentialing. It is provided temporarily.

Here, We Explain Step-by-Step the Process of How to Get Credentialed with Medicaid

Determine Your Eligibility

?It is important to determine your eligibility before starting the credentialing process. To participate in Medicaid, you must:

• Be a licensed physician enrolled in Medicare or eligible to enroll.
• Have a National Provider Identifier (NPI) number and Tax Identification Number (TIN).

Complete Application

Once you have successfully determined the eligibility process, you can start the application process. The application for Medicaid credentialing varies from state to state, so you should contact your state’s Medicaid agency to get appropriate instructions and forms.

The application will generally require certain information about your practice such as your TIN and NPI numbers, address, business name, and license information. You will also need to provide information about your training, education, and experience, and any malpractice claims, or any such disciplinary actions taken against you.

Supporting Document Submission

You must submit your supporting documents along with your application such as copies of your license, DEA registration, and malpractice insurance. You may also be required to document your education, experience, and training. It is necessary to ensure that your supporting documents are accurate and current. Many people are heard saying how long does it take to get credentialed with Medicaid. This query is conditional as it depends on the accuracy of the supporting document that you submit. If the supporting documents you submitted are accurate and current, the credentialing process will proceed quickly and vice versa.

Wait For Approval

Once you submit your application and supporting documents, wait for approval. The duration of the credentialing completion process in the U.S. varies from state to state, ranging from a few weeks to several months. During this time, the Medicaid agency may contact you for additional information or to schedule a site visit to your practice.

Complete Enrollment and Contracting

You must complete the enrollment and contracting process after being approved for Medicaid credentialing. This includes signing a provider agreement with the Medicaid agency and agreeing to comply with all program requirements, such as maintaining accurate patient records and submitting claims for covered services. Depending on your state’s Medicaid program, you may also need to complete additional education or training requirements.

Begin Providing Services

Once you complete your enrollment and contracting process, now you are authorized to provide services to Medicaid patients. But make sure you have a thorough understanding of the billing procedures and program requirements to ensure you are reimbursed correctly for your services.?

Importance Of Credentialing with Medicaid for Healthcare Providers

Credentialing with Medicaid offers potential growth opportunities for healthcare providers looking to expand their patient volume and diversify their services to underserved populations. Here, we discuss its importance. Broader Patient Spectrum

Credentialing with Medicaid increases your patient base through Medicaid programs. The reason behind this healthcare program is to facilitate Medicaid beneficiaries who often face difficulties in accessing healthcare. By becoming a Medicaid provider, you can easily reach out to these patients and provide them with much-needed care.

A Steady Stream of Revenue

Credentialing with Medicaid ensures a never-ending revenue stream for healthcare providers. Medicaid reimburses physicians for the services they provide to beneficiaries. Once you have become a Medicaid provider, you are assured of having access to a reliable source of revenue.

Accessibility to Additional Resources

Medicaid-credentialed healthcare providers get access to additional resources. The program often offers learning opportunities, training, and other resources that help healthcare providers improve their skills and provide better patient care.

Enhanced Patient Results

Medicaid programs are designed in a way that enhances patient results to ensure that beneficiaries have easy access to quality healthcare. By participating in Medicaid programs, physicians can contribute to this goal and enhance patient outcomes.

Elevated Industry Trust

Credentialing with Medicaid also elevates providers’ professional trust in the industry. Medicaid programs have well-established but strict standards for credentialing, and by qualifying this criterion, healthcare providers demonstrate their commitment to providing exceptional patient care.

Expanded Patient Reach

?According to the Kaiser Family Foundation’s 2020 report, over 68 million people were enrolled in Medicaid and CHIP (Children’s Health Insurance Program) by that time. These are the benefits that come along with being credentialed with Medicaid. You become authorized to provide healthcare services to this large patient population enrolled in Medicaid which includes low-income families, individuals with disabilities, and pregnant women.

Reimbursement For the Services Provided

It is essential that Medicaid credentialed provider gets reimbursed for the healthcare services provided to Medicaid beneficiaries. It means that by getting credentialed with Medicaid, you get access to uninterrupted cash flow from Medicaid for the healthcare services you provide to eligible beneficiaries.

Conformance with Regulatory Requirements

?Credentialed healthcare providers need to conform to federal and state regulatory requirements related to the Medicaid program. By getting credentialed with Medicaid, you will be required to adhere to the regulations about billing, documentation, and other related aspects of providing healthcare services to Medicaid beneficiaries. Conformance with these regulations is essential to avoid fines, penalties, and legal actions.

Increased Revenue

?It drives potential revenue growth to your practice when you become credentialed with Medicaid and start providing services to Medicaid beneficiaries. It helps you generate revenue that you would not have had otherwise. Compared with private insurance rates, Medicaid reimbursement rates are generally lower but can still help you increase your patient volume and overall revenue while offering healthcare services to the underserved population.

How to Avoid Medical Credentialing Mistakes

Medical credentialing mistakes can prove largely counterproductive to your practice’s financial health and practicing these mistakes can cost you time and money penalties.

Here, we share a few important strategies to help you avoid credentialing mistakes in the healthcare industry.

• Staying informed and updated on the ever-evolving changes is important to avoid any credentialing mistakes. Once you are aware of the steps, procedures, and requirements, you can effectively process your credentialing according to the latest trends. Moreover, you can use advanced software specifically designed for credentialing services to accelerate the process.
• It is worth suggesting to cross-check all your credentialing data to avoid credentialing mistakes. By checking all your credentialing information, you ensure that the credentialing information provided is correct and up to date.
• The key to getting smooth credentialing is to stay transparent in your credentialing process. Be truthful about any malpractices, failings, and work history to avoid delays or rejections.
• Another common mistake to avoid credentialing with Medicaid is avoiding communication. You must have consistent, regular, and engaging communication with the credentialing team to stay updated with the current trends and avoid credentialing errors in your application.
• Keep all your documents, licenses, or registration organized and updated to make them easily accessible to the credentialing team which is essential to streamline your credentialing system.

Conclusion

The process of credentialing with Medicaid can be time-consuming and complex. However, it is really important for healthcare providers looking to expand their clients’ base and increase access to healthcare services for low-income families and individuals.

By following the steps, we have discussed above and working with your state’s Medicaid agency, you can become credentialed with Medicaid and as an authorized physician, you can start providing services to those in need. By doing so, you can enjoy numerous benefits which include increased patient volume, access to resources, a steady revenue stream, improved patient outcomes, and professional credibility you get by being a Medicaid provider.

We at Billing Care Solutions deploy the best resources and technology to manage and organize physician applications to ensure that your credentialing process proceeds efficiently. Our staff is the most cooperative, competent, and approachable to get you credentialed with Medicaid as soon as possible. Partner with us right now to start your career as an approved and incredible physician. ?