Remove Download Remove Governance Remove Licensing Remove Medicare
article thumbnail

Navigating Mental Health Credentialing

MedTrainer

Credentialing confirms the providers’ eligibility to bill for services under government and accreditation regulations. It can also be a prerequisite for enrolling with an insurance network or Medicare for the first time. Download Now That’s the process of credentialing one mental health provider with one payer. Effective Jan.

article thumbnail

Aetna Provider Enrollment: What To Expect

MedTrainer

Here are the key steps: Gather Training and Education Gather Licensing and Certification Gather Work History Details Gather Payer-Specific Requirements Following Application Submission Get the tools you need to eliminate delays in your provider enrollment process. Easily assign multiple enrollments to staff, update statuses, and prioritize.

Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

The Importance of Primary Source Verification for Practitioner Credentials

Verisys

State licensing boards verify practitioner license type and status. 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. Here are some examples: Medical schools verify completion of education.

article thumbnail

How To Prepare for an OIG Inspection

MedTrainer

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. Download “Compliance Reports You Can’t Live Without” for OIG reporting templates and tips. Medicare/Medicaid Compliance Reviews. What Prompts an OIG Inspection?

Fraud 98
article thumbnail

Navigating the Maze of Who Regulates Healthcare Compliance

MedTrainer

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Here are some of the key organizations involved in regulating healthcare compliance: Centers for Medicare & Medicaid Services (CMS): CMS is a federal agency within the U.S.

article thumbnail

Privileges and Credentialing Aren’t the Same

MedTrainer

The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Download Now What are Provider Privileges? Whether it’s government regulation or healthcare facility requirements is a matter. Look for these 10 attributes in a credentialing specialist.

article thumbnail

Preventing Unlicensed Individuals and Subsequent Fraudulent Claims Submission

Provider Trust

District Attorney alleges that Pickering was hired in 2019 as a licensed physician’s assistant at a family practice in Norcross, Georgia but had not been a licensed physician’s assistant in Georgia, or any state, since March 2014. The Importance of Conducting License Verification and Monitoring. According to the U.S.