Medicare has started the 3 year effort to re-validate ALL Medicare providers!nnYou will be receiving a notification letter. You (the provider) only have 60 days to complete and submit the proper forms that must be completed.nn
Credentialing is NOT just filling out paper work…nCredentialing IS an increasingly complex and time sensitive process where the right information has to get to the right place, correctly, (even in the right color ink) and on-time in order for you to be paid correctly and consistently!nnFailure to properly fill out the “paper work” will cause, and has been causing disruptions in payment, inability to obtain referrals, improper co-pay and deductibles being applied and even regulatory audits (when a provider is mis-categorized and loaded improperly in the payer’s system!).nnIf your practice is experiencing:n
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- Slow payments from some payer sources
- Incorrect payments based on your contracts
- Incorrect copay amounts applied (i.e. you are a specialist and the PCP copay is applied)
- Sporadic claim denials on standard CPT codes
- Trouble with pre—cert or referral authorizations
- Backlogs of re-credentialing applications, CAQH updates, etc
- Disorganization and backlogs in getting a new provider credentialed and contracted.
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n…You need assistance with Credentialing!nCall us at 303.534.0388 or email us at info@WHPelter.com!nnWe have an entire credentialing department ready and willing to assist with these issues and help get your practice back on track!nnAdditional Important Credentialing Updates:nn Effective October 29, 2012 Novitas Solutions, Inc. (formerly Highmark Medicare Services) will become the new Medicare Contractor (MAC) for Colorado (no longer Trailblazer). With this transition, Novitas will REQUIRE new EFT’s (form 588) be completed and submitted for ALL practices and providers! Failure to complete an updated 588 for Novitas will result in claims denials and disruptions in your cash flow!nn Medicare has started the 3 year effort to re-validate ALL Medicare providers!n You will be receiving a notification letter. You (the provider) only have 60 days to complete and submit the proper forms that must be completed.nn All Physical Therapy Assistants must be certified by the State Physical Therapy Board by June 1, 2012 in order to work as a PTA in Colorado! To learn more, visit www.dora.state.co.us.nn Ensure your physicians/providers PECOS enrollment information is up to date! Failure to do so can result in unexpected denials of claims due to the provider being terminated from Medicare!nn Effective July 1, 2012 there will be a change in copay amounts for some Child Health Plan Plus (CHP+) State Managed Care Network members. Members will begin receiving new ID cards in June with the updated copay amount.nn Practices that employ a Surgical Assistant will be required to go through a new and more extensive credentialing process with HealthOne facilities in order to maintain privileges. The new process is more time consuming so start early! nn If you need assistance with any of the above, please call or email us!