Common Issues when Medicare Credentialing

I notice when I do consulting with those wanting to credential (or even bill) Medicare, these are some common issues I see. Keep this checklist handy for when you’re working on credentialing!

If you have formed an LLC, you need a NPI2. A lot of folks credential with other insurers without this, but Medicare requires that if you have an LLC formed (even if it’s just you and you have no employees) that you get a NPI2.

Set yourself up in the CMS Identity and Access System (I&A). This part (understandably) confuses a lot of people. I&A manages your NPI, PECOS, and EHR Incentives (most of us do not use this part) using just one login. You will set yourself up as an authorized official and make sure you keep this password current (and write it down somewhere safe). You can view your Medicare enrollment, track the application status, and view/update information.

Know which application you are applying for. If you are a sole provider, you will do the 855i. If you are a group (or have an LLC as I mentioned above) you will need to complete the 855b (for the group/organization) AND the 855i (for the individual provider)

Have your documents ready. You’ll need your bank account information (must match your business name), your address, your NPI, your clinical license, and in some instances, your degree. It’s a lot quicker if you already have this information close by when you are applying or scanned and saved as a pdf on your computer.

Prepare yourself emotionally. Seriously, not trying to be dramatic! It’s really not that bad but I find a lot of people have created scenarios about how awful the application process is. The application takes time, just like anything else, and can feel overwhelming and also a bit redundant. Helps to know this ahead of time, and preparing yourself with the other items will also help with any frustrations. Set aside a chunk of time where you can focus on completing this and remember why you want to serve Medicare clients!

And one more as a bonus ;)

Ask for help. We have our whole Medicare Community to support you and I am here for 1:1 consulting if you need more assistance

Need more help? Schedule a free discovery call with me here.