Medicare and Medicaid Contracting

Why Doctors Need to Do Medicare Enrollment & Re-validation

In order to have Medicare billing privileges, physicians are required to have an active contract with their local Medicare contractor. They need to maintain active PECOS account as well for efficient communication and faster contracting. Medicare also requires providers to re-validate their contracts every five years. If provider fails to do this, he/she will lose Medicare billing privilege and have to start a new application process.

Do Physicians Need to be Enrolled with Medicaid

Providers who want to participate with state healthcare programs must be contracted with state specific Medicaid. If a provider is not contracted, no claim for that provider will receive payment. Private medical practices will enroll with traditional fee-for-service with Medicaid. Providers will need to enroll through their local Medicaid portals. This is the best way to communicate with provider services. State Medicaid will also require periodic re-validation. Timing for re-validation is state specific. Requirements are also state specific.

We can take away the headache of dealing with complicated insurance requirements and ensure all contracts are active and all information is updated. We have extensive experience with enrollment and re-validation for Medicare and Medicaid. We can help providers create PECOS and Medicaid accounts and submit and process all applications.  We keep constant contact with all insurance Provider Service departments to keep updates on applications and requirements.

Medicare Revalidation

Who We Work With

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Dermatologists
  • Ophthalmologists
  • Optometrists
  • Psychiatrists
  • Plastic Surgeons
  • General Surgeons
  • Mental Health Providers
  • Gastroenterologist

FAQ

Medicare re-validation is the renewal of Medicare contract. For private practices, contracts need to be re-validated every five years. Through re-validation, Medicare ensures it has updated information from providers.

PECOS (Provider Enrollment, Chain, and Ownership System) is the online portal for Medicare. PECOS makes communication with Medicare very efficient.

MS 855B form is used for Medicare enrollment application by clinics, group practices, and physicians.

855R form is used for Reassignment of benefit for Medicare providers. Practitioners who want to direct Medicare payments to an entity will use this form.