Provider/Supplier Enrollment

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The Provider Enrollment Section primarily is focused on providing services to individual and organizational health care providers and suppliers wishing to enroll/participate in the Medicare, Medicaid and commercial third party payor programs. As provider enrollment requirements become increasingly complicated, the range of services we provide has expanded commensurately to accommodate this new trend. Our approach...Read More

The Provider Enrollment Section primarily is focused on providing services to individual and organizational health care providers and suppliers wishing to enroll/participate in the Medicare, Medicaid and commercial third party payor programs. As provider enrollment requirements become increasingly complicated, the range of services we provide has expanded commensurately to accommodate this new trend. Our approach is two-fold: (1) guiding providers through legal and/or regulatory processes; and (2) acting as a liaison between providers and the governmental agencies and contractors that oversee the provider enrollment process.

Upon request, we provide assistance in interpreting the applicable participation requirements, completing provider enrollment documentation and assisting with appeals of adverse enrollment decisions. Important aspects of provider and supplier enrollment are timely submissions and keeping abreast of the disclosure requirements applicable to particular providers and suppliers; therefore, we provide timely and efficient advice to our clients, as well as frequent alerts via email as requirements are proposed or revised.

For providers seeking to respond to adverse enrollment decisions, we provide assistance in addressing any areas identified for improvement, revising enrollment applications and/or appealing adverse decisions. We have developed close working relationships with representatives of state and federal agencies, such as CMS, and many of the administrative contractors for the Medicare and Medicaid programs, which have proven to be invaluable to our clients.

The Provider Enrollment Section also coordinates with other Hall Render sections to offer the knowledge and skills required for effecting changes of ownership to ensure a smooth transition in these transactions. We prepare and file the necessary enrollment documentation and notifications pursuant to local, state and federal mandates. Timely and accurate filings, as well as continued follow-up, help our clients remain compliant and enjoy uninterrupted reimbursement.

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Areas of Focus

  • CMS-855
  • Enrollment Applications
  • Enrollment Decision Appeal
  • Internet-Based Provider Enrollment Chain and Ownership System (PECOS)
  • National Plan and Provider Enumeration System (NPPES)
  • National Provider Identifier (NPI)
  • Provider/Supplier Enrollment
  • Revalidation