MedTrainer

FEBRUARY 5, 2024

In this blog, we’ll discuss the two processes and key differences between provider enrollment and credentialing. Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. So, what is the difference between provider enrollment and credentialing?

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MedTrainer

MAY 6, 2024

This blog will highlight how credentialers can navigate Aetna provider enrollment. As a healthcare organization, you understand the importance of working with insurance payers to ensure smooth and timely reimbursement. The challenge is meeting each payer’s unique provider credentialing and enrollment process requirements.

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Verisys

DECEMBER 5, 2023

An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs.

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Governance Licensing Malpractice Medicaid 52

Verisys

AUGUST 31, 2023

Here are seven red flags to look out for and the reasons why: Incomplete or inconsistent application: Missing or conflicting data regarding education, training, work history, licensure, or malpractice history might indicate false information or attempts to conceal relevant details.

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MedTrainer

JULY 28, 2023

OIG Inspections in Healthcare The OIG focuses its resources on oversight of Medicare and Medicaid — programs that represent a large portion of the federal budget. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers. What Is the Scope of an OIG Inspection?

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MedTrainer

MARCH 14, 2024

Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority. Whether it’s government regulation or healthcare facility requirements is a matter. Upon completion and approval, the provider can begin billing for medical services.

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Malpractice Licensing Hospitals Compliance 52

MedTrainer

NOVEMBER 27, 2023

Ohio Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Ohio Department of Health (ODH) is key to safeguarding and enhancing the health of Ohio residents. The license is valid for three years unless revoked.

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