Medicare & Medicaid Credentialing

TriumpHealth provides expert solutions for seamless provider enrollment with Medicare and Medicaid, covering all specialty types.

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PROVIDER CREDENTIALING & PAYER ENROLLMENT

Streamlined Government Payer Enrollment for Healthcare Providers

Whether you’re a physician, therapist, dental or mental health provider, an FQHC, home health agency or DME supplier, enrolling in Medicare and Medicaid programs is essential to serve a wider patient base and increase revenue. At TriumpHealth, we simplify the complex Medicare provider enrollment and Medicaid services CMS processes, so you can focus on care, not paperwork.

Medicare application form with marked plan A and B.

Why Medicare & Medicaid Enrollment Matters

To participate in government-sponsored healthcare programs like Medicare and Medicaid, you must complete a rigorous enrollment process. This involves submitting accurate provider data, ownership details, and compliance documentation to federal and state agencies.

With our expert team, you will navigate the application process quickly and efficiently, avoiding delays that can impact patient access and cash flow.

What We Handle

Completion and submission of your Medicare Enrollment Application
State-specific Medicaid enrollment processing
PECOS application setup and maintenance
Guidance on paper applications where required
Coordination with Medicare Administrative Contractors (MACs)
Help with Electronic Funds Transfer (EFT) enrollment

Management of Durable Medical Equipment (DME) supplier credentials
Updates to Practice Location, Tax ID, or contact changes
Disclosure of Adverse Legal Actions, if applicable
Filing within the Enrollment Chain and Ownership System (PECOS ECOS)
Real-time enrollment status tracking

Who We Serve

Physicians and Specialists
Dental Practices
Mental & Behavioral Health Providers
Therapists and Counsellors

DME Suppliers
Office Managers and Admin Staff
Healthcare Executives

We handle single-provider enrollment, as well as large group or multi-location practices.

Required Documents & Details

To complete your Medicare and Medicaid enrollment, we’ll help collect and verify:

Provider identification and licensure
Practice location and contact details
Legal business structure and chain and ownership system information
Electronic Funds Transfer (EFT) bank details

W-9 and tax ID verification
Adverse legal action disclosures
Program-specific forms (like DMEPOS applications)
Prior certifications and accreditations

Our credentialing team ensures that each PECOS application and paper application meets the strict compliance standards of CMS and state agencies.

Stay Compliant, Stay Enrolled

Failure to update your Medicare provider enrollment can lead to deactivation, delayed reimbursements, or investigations. Providers are legally required to notify payers of:

Changes in executives or ownership
Addition or change of practice location

Any adverse legal action or sanctions
Updates to contact information or affiliations

TriumpHealth ensures all updates are filed on time, helping you stay compliant and audit-ready.

Timelines & Processing

Typical processing timeframes include:

Medicare: ~45 business days from submission

Medicaid:~90 days (varies by state)

We streamline your enrollment process by communicating with MACs, monitoring your enrollment status, and resolving any issues that may arise during verification.

Frequently Asked Questions

Q 1: What is PECOS, and why do I need it?
PECOS (Provider Enrollment, Chain, and Ownership System) is the online system used to manage Medicare provider enrollment. It allows providers to submit and track applications electronically, replacing traditional paper applications.

Q 2: How does TriumpHealth assist with DMEPOS enrollment?
We guide DMEPOS suppliers through the specific Medicare enrollment application, compliance standards, and CMS-accreditation requirements to ensure approval and faster participation in the Medicare program.

Q 3: What happens if I’ve had an adverse legal action?
We help providers disclose and document adverse legal actions as required, while offering strategies to avoid penalties or denials during enrollment.

Q 4: Can you help with law enforcement-related compliance or audits?
Yes. If law enforcement or regulatory review is involved, we help compile documentation and coordinate responses related to provider enrollment.

Ready to Start? Let’s Enroll You Today.

From PECOS setup to electronic funds transfer forms and Medicare administrative contractor MAC coordination, TriumpHealth is your trusted partner for seamless Medicare & Medicaid enrollment. For more information Call us at (888)-747-3836 X0 or Email us at [email protected]

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Medicare & Medicaid Enrollment FAQ

Our Process

Application Submission

We initiate the process by submitting credentialing applications to the Centers for Medicare & Medicaid Services (CMS) or the respective state Medicaid agency, depending on the program. These applications entail provider information, education, training, licensure, certification, and practice history, tailored to meet the specific requirements of Medicare and Medicaid.

Verification and Review

The credentialing entity, such as CMS or the state Medicaid agency, conducts thorough verification and review of the information provided in the credentialing applications. This process involves verifying provider credentials, including licenses, certifications, education, training, work history, malpractice history, and professional references. Primary source verification is often employed to ensure the authenticity of credentials.

Committee Review and Decision

Credentialing committees or boards within CMS or the state Medicaid agency review the verified information and make credentialing decisions based on established criteria and standards set forth by the respective program. This review process includes evaluating the provider’s qualifications, competence, ethical conduct, and adherence to program requirements. If the provider meets the credentialing requirements, the committee approves the provider’s credentialing application for Medicare or Medicaid participation.

Contracting and Enrollment

Upon successful credentialing, the medical practice may enter into agreements with CMS or the state Medicaid agency to participate in the Medicare or Medicaid programs. These agreements outline the terms of participation, reimbursement rates, and contractual obligations specific to Medicare or Medicaid. Once agreements are finalized, providers are enrolled in the respective programs, allowing them to provide covered services to eligible beneficiaries.

Benefits of Working with TriumpHealth

Medicare and Medicaid Enrollment

Expert Guidance

Our enrollment specialists stay up-to-date with the latest regulations to ensure compliance with both federal and state requirements.

Accuracy

Meticulous attention to detail guarantees that forms are filled correctly on the first submission, avoiding time-consuming corrections and resubmissions.

Customizable Services

Whether you’re a solo practitioner or a large healthcare network, our services are scaled to your specific needs.

Continued Support

Post-enrollment, we remain at your beck and call for any updates or inquiries.

Maximize Your Revenue. With Expert RCM Services

Book Your Free Consultation Now

Schedule a consultation today to achieve financial success and regulatory compliance. Let us help you improve patient outcomes while increasing your revenue.

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