PROVIDER ENROLLMENT SERVICE

PACKAGE FOR ALL PROVIDER TYPES

Provider Enrollment is the process of enrolling a provider with insurance payers, including Medicaid, Medicare, MCOs, and private/third-party insurance, so that they can request payment from those payers. Provider Enrollment process ensures that a provider gets approved to participate in an insurance network, and establishes the provider's eligibility to bill a particular payer.

Provider Credentialing is typically done before a healthcare provider is allowed to participate in an insurance network. Provider credentialing ensures claims don't get denied.

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OUR PROVIDER ENROLLMENT SERVICE IS ONLY AVAILABLE TO LICENSED PROVIDERS & THOSE FOR WHOM LICENSURE IS REQUIRED BY THEIR STATE

State-by-State Regulations on Training Requirements

Alabama: Follows the Federal Code of Regulations: CFR Title 42, Vol. 3, 484. Alaska: Alaska Administrative Code, Title 7, 12.519. Arizona: Arizona Revised Statutes, Title 36, Article 2, 36.2939 (B.2.a). Arkansas: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. California: California Code of Regulations, Title 22, Division 5, Chapter 6, §74747. Colorado: Code of Colorado Regulations, 10 CCR 2505‐10 8.525. Connecticut: Connecticut Department of Public Health Regulations, Public Health Code, Title 19‐13‐D69. DC: District of Columbia Municipal Regulations, Title 17, Chapter 93, §9327.3. Delaware: Delaware Administrative Code, Title 16, §4406. Florida: Florida Administrative Code, Rule Chapter 59A‐8.0095. Georgia: Follows Federal Code of Regulations: CFR Title 42, Vol.3, 484. Hawaii: Hawaii Administrative Rules, Title 11, Chapter 97, Section 1. Idaho: Idaho Administrative Code, IDAPA 16.03.07. Illinois: Illinois Administrative Code, Title 77, §245.70; 77 IL Admin. Code §395.150. Indiana: Indiana Code 16‐27‐1.5‐1 Iowa: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. Kansas: Kansas Administrative Regulations 28‐51‐100. Kentucky: Follows Federal Code of Regulations: CFR Title 42, Vol.3, 48 Louisiana: Follows Federal Code of Regulations: CFR Title 42, Vol.3, 484. Maine: Code of Maine Rules, 10‐144, Chapter 119. Maryland: Code of Maryland Regulations, Title 10.39.01.08. Massachusetts: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. Michigan: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. Minnesota: Minnesota Administrative Rules, 4664.0260. Mississippi: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. Missouri: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. Montana: Montana Department of Public Health and Human Services, Policies and Procedures, State Certification of Competency for Home Health Aides. Nebraska: Nebraska Administrative Code, Title 175, 14‐006.04G5. Nevada: Nevada Department of Health & Human Services, Medicaid Service Manuals, 1403.8. New Hampshire: New Hampshire Code of Administrative Rules, Chapter He‐W 553. New Jersey: New Jersey Administrative Code, Title 13:37‐14.4. New Mexico: New Mexico Administrative Code, 7.28.2.30.C. New York: New York Codes, Rules, and Regulations (NYCRR), Title 10, § 700.2., New York State Department of Health North Carolina: Division of Medical Assistance, Medicaid Clinical Coverage Policies and Provider Manuals, Clinical Coverage Policy No.: 3A (6.2). North Dakota: North Dakota Administrative Code, 33.03.10.1.18. Ohio: Ohio Administrative Code, 5160-12-03. Oklahoma: Oklahoma Administrative code, Title 310, 677-9-4. Oregon: Oregon Administrative Rules, 410‐127‐0020. Pennsylvania: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. Rhode Island: Rhode Island Rules and Regulations, R23‐17‐HNC/HC/PRO. South Carolina: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. South Dakota: South Dakota Administrative Code, 67‐16:05:01. Tennessee: Rules of the Tennessee Department of Health, Board of Licensing Health Care Facilities, Chapter 1200.08.26. Texas: Texas Administrative Code, Title 40, Part 1, Chapter 97, Sub-Chapter D, §97.701. Utah: Utah Administrative Code, Rule R432-700-22. Vermont: Regulations for the Designation and Operation of Home Health Agencies, Part X, 10.1. Virginia: Virginia Administrative Code, Title 12, Agency 30, Chapter 50, Section 160. Washington: Washington Administrative Code, 246- 335-015-23. West Virginia: Follows Federal Code of Regulations: CFR Title 42, Vol. 3, 484. Wisconsin: Wisconsin Administrative Code, Chapter DHS 129, Certification of Programs for Training and Testing Nurse Aides, Medication Aides and Feeding Assistants, Subchapter II. Wyoming: Wyoming Department of Health, Aging Division, Rules for Program Administration of Home Health Agencies, Chapter 9.
What services does Waiver Consulting Group offer?

Waiver Consulting Group offers a wide range of services including provider enrollment assistance, regulatory compliance consulting, policy and procedure development, accreditation support, and more. We specialize in helping healthcare agencies navigate the complexities of Medicaid waivers and related programs.
How can Waiver Consulting Group help with provider enrollment?

We provide comprehensive assistance with Medicaid and Medicare provider enrollment, including completing application forms, gathering required documentation, and ensuring compliance with state and federal regulations. Our goal is to streamline the enrollment process and help agencies start providing services as quickly as possible.
What is the process for getting started with Waiver Consulting Group?

Getting started with us is easy! STEP #1: Initial Consultation Contact us to schedule an initial consultation; Complete the GETTING STARTED form or use our START UP WIZARD to begin. We will send you an invite to our Client Portal and call you to follow up. The invitation to collaborate will be followed by several emails from us about tasks and to-dos for you to complete. These will be followed by a phone call. During the call, confirm your specific needs, goals, and challenges; and ask questions you may have. Be prepare to provide relevant information about your agency, such as services and population type, and any specific areas where you require assistance. (If applicable) STEP #2: Invitation To Collaborate (ITC) Based on the initial consultation, we update your Client Portal. We provide a complimentary market research on your selected service type, proposed location, applicable state, and federal regulations, competitors, branding, and more if requested! Waiver Consulting Group will send you a detailed process outlining your chosen services, scope of work, and timeline to address your agency's needs and achieve your goals. This is sent via an email invite to our Client Portal. STEP #3: Engagement & Collaboration Upon your completion of your ONBOARDING TASK LISTS assigned to you in the Client Portal, you enter into an engagement agreement with Waiver Group on completing your goal. Our Client Portal is where you will follow the progress of your application process. Collaborate with Waiver Consulting Group throughout the engagement, participating in phone meetings, sharing feedback, and actively engaging in the consulting process.
Can Waiver Consulting Group help with regulatory compliance?

Yes, we offer regulatory compliance consulting to help agencies stay compliant with state and federal regulations. We can assist with policy development, staff training, audits, and ongoing compliance monitoring to ensure your agency operates ethically and legally.
Does Waiver Consulting Group offer training and education services?

Yes, we provide training and education services for healthcare agency staff, including caregivers, nurses, administrators, and managers. Our training programs cover a wide range of topics, including regulatory requirements, best practices, and patient care standards.
How long does it typically take to see results with Waiver Consulting Group?

The timeline for seeing results can vary depending on the specific services you require and the complexity of your agency. However, we strive to deliver timely and effective solutions, and our team works diligently to achieve positive outcomes for our clients. In most starts, licensing process takes 60 to 90 days while others take up to 90 to 180 days. We encourage our clients or potential clients to plan ahead.

ABOUT PROVIDER ENROLLMENT

GET ENROLLED AS A PROVIDER

MEDICAID PROVIDER ENROLLMENT

What You Get:

MEDICAID APPLICATION PREPARATION: We help clients complete and submit the necessary Medicaid provider applications, ensuring that all required information is accurate and up-to-date.

FOLLOW-UP COMMUNICATION: We liaise with Medicaid agencies on behalf of our clients, facilitating communication and addressing any inquiries or requests for additional information during the enrollment process.

PROVIDER CREDENTIALING: We assist clients in the credentialing process, which may involve verification of qualifications, background checks, and ensuring compliance with Medicaid provider standards.

MEDICAID BILLING SETUP: We help clients set up their billing systems and procedures to ensure accurate and efficient claims processing and reimbursement.

MEDICAID COMPLIANCE: We provide guidance on Medicaid compliance requirements, helping clients understand and meet the regulatory standards necessary for provider enrollment.

PROVIDER EDUCATION: We offer training and education to help clients stay informed about changes in Medicaid regulations and requirements.

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Provider Enrollment

MEDICARE PROVIDER ENROLLMENT

What You Get:

MEDICARE APPLICATION ASSISTANCE: We guide clients through the Medicare provider application process, ensuring all necessary forms are completed accurately and submitted on time.

DOCUMENT PREPARATIOIN: We help gather and organize the required documents and credentials, such as licenses, certifications, and insurance, to meet Medicare's standards.

COMPLIANCE GUIDANCE: We ensure that healthcare agencies are compliant with all Medicare regulations and requirements, including the Centers for Medicare & Medicaid Services (CMS) guidelines.

CREDENTIALING SUPPORT: Our team assists with the credentialing process, including the enrollment of individual healthcare providers to ensure they can bill Medicare for services.

BILLING SYSTEM SETUP: We help clients establish effective billing systems and procedures to submit claims to Medicare accurately and efficiently.

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INDIVIDUAL APPLICATION:

The CMS-855I is the paper application for Physicians and Non-Physician Practitioners. This application is for initial enrollment in the Medicare program or changes to your existing Medicare record. The application is 27 pages and is processed by the Medicare Administrative Contractor (MAC) responsible for managing the jurisdiction in which you are applying. There are 12 different MACs managing CMS programs across the country. It is important that your application be submitted to the MAC responsible for your state.

GROUP/AGENCY APPLICATION:

The CMS-855B application is for Clinics/Group Practices and certain other providers. This application is to enroll your business entity with Medicare so that payment for rending provider services can be paid to the business entity. For medical groups, this application is required if the entity is owned by more than one person or by a person other than a provider enrolling under the entity. If a solo practitioner is the sole owner of a business entity, then this application is not required. In the case of solely owned business entities, you can complete your entity enrollment application on the individual application 855I.

In order for a group application to be processed, there must also be at least one provider enrolling for re-assignment to the group. You cannot simply enroll a medical practice without having providers to treat Medicare beneficiaries.

REASSIGNMENT OF BENEFITS:

This paper form is used to re-assign a providers Medicare benefits to an organization. After forming a business entity and enrolling the business entity with Medicare, your employed providers can re-assign payments for services rendered to your organization so that all payments are made to your practice under the single tax id. Providers can have multiple re-assignments active at anytime for multiple employers. In order to re-assign benefits a provider must first have an individual enrollment record (CMS855I) and the organization must have an enrollment record (CMS855B).

If a provider is changing employers within a Medicare jurisdiction, you may only need to file an 855R to re-assign your benefits to your new employer. You will also need to terminate your re-assignment with the previous employer.

PECOS is the online enrollment system for CMS. Providers may utilize PECOS to submit initial enrollment applications or to make changes to existing enrollment records. PECOS allows for electronic signature of applications making the process more efficient. There are some pitfalls to utilizing PECOS however. Some of the MACs are not efficient at downloading and updating PECOS with submitted applications. There are many situations of lost data or incorrect import of information from PECOS to the MAC application processor. It is therefore very important to know the details of your application submission and follow up on a regular basis to ensure your PECOS application is handled correctly.

PRIVATE PAYER/
INSURANCE ENROLLMENT

What You Get:

INSURANCE VERIFICATION: We help healthcare agencies determine which private insurance payers they should enroll with based on their services and target patient population.

APPLICATIOIN ASSISTANCE: We guide clients through the application process for each selected private insurance payer, ensuring all required forms and documents are completed accurately and submitted on time.

CREDENTIALING SUPPORT: We assist with the credentialing process, ensuring that individual healthcare providers within the agency are properly enrolled with private payers to bill for services.

DOCUMENT PREPARATION: We help gather and organize the necessary documents and credentials, such as licenses, certifications, and insurance, to meet each private payer's standards.

COMPLIANCE GUIDANCE: We ensure that healthcare agencies are compliant with the specific requirements and regulations of each private insurance payer.

BILLING SYSTEM SETUP: Our team helps clients establish effective billing systems and procedures to submit claims to private payers accurately and efficiently.

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ACHC ACCREDITATION

What You Get:

INITIAL ASSESSMENT: We conduct a comprehensive assessment of the healthcare agency's current operations and policies to identify areas that need improvement to meet ACHC standards.

POLICY & PROCEDURE DEVELOPMENT: We assist in the development and customization of policies and procedures to align with ACHC accreditation standards.

STAFF TRAINING: We provide training programs for agency staff to ensure they understand and can implement ACHC compliance requirements effectively.

MOCK SURVEYS & READINESS REVIEW: We conduct mock surveys and readiness reviews to prepare healthcare agencies for the official ACHC accreditation survey.

DOCUMENTATION REVIEW: We review and organize all required documentation, ensuring it meets ACHC standards for submission.

ACCREDITATION APPLICATION ASSISTANCE: We assist in completing the accreditation application, ensuring that all necessary information is included.

ONSITE SURVEY PREPARATION: We help healthcare agencies prepare for the onsite survey conducted by ACHC surveyors.

SURVEY SUPPORT: We offer support during the official accreditation survey, assisting in responding to surveyor inquiries and addressing any concerns.

CONTINUOUS COMPLIANCE MONITORING: We provide ongoing support to maintain compliance with ACHC standards after accreditation is achieved.

CORRECTIVE ACTION PLANS: If deficiencies are identified during the survey, we assist in developing and implementing corrective action plans to address them.

ACCREDITATIOIN RENEWAL: We help agencies prepare for the renewal of their ACHC accreditation, ensuring continued compliance.

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THE JOINT COMMISSION ACCREDITATION

What You Get:

INITIAL ASSESSMENT: We conduct a thorough assessment of the healthcare agency's current operations and policies to identify areas that need improvement to meet The Joint Commission standards.

POLICY & PROCEDURE DEVELOPMENT: We assist in the development and customization of policies and procedures to align with The Joint Commission's accreditation standards.

STAFF TRAINING: We provide training programs for agency staff to ensure they understand and can implement The Joint Commission's compliance requirements effectively.

MOCK SURVEYS & READINESS REVIEWS: We conduct mock surveys and readiness reviews to prepare healthcare agencies for the official Joint Commission accreditation survey.

DOCUMENTATION REVIEW: We review and organize all required documentation, ensuring it meets The Joint Commission's standards for submission.

ACCREDITATIOIN APPLICATION ASSITANCE: We assist in completing the accreditation application, ensuring that all necessary information is included.

ONSITE SURVEY PREPARATION: We help healthcare agencies prepare for the onsite survey conducted by Joint Commission surveyors.

SURVEY SUPPORT: We offer support during the official accreditation survey, assisting in responding to surveyor inquiries and addressing any concerns.

CONTINUOUS COMPLIANCE MONITORING: We provide ongoing support to maintain compliance with The Joint Commission's standards after accreditation is achieved.

CORRECTIVE ACTION PLANS: If deficiencies are identified during the survey, we assist in developing and implementing corrective action plans to address them.

ACCREDITATION RENEWALS: We help agencies prepare for the renewal of their Joint Commission accreditation, ensuring continued compliance.

Contact Us

Our Provider Enrollment services are designed to empower service providers with right tools and relationships to get paid for services they provide.

To Get Started:
Call: (302) 888-9172

PROVIDER ENROLLMENT SERVICE

PACKAGE FOR ALL PROVIDER TYPES

OUR PROVIDER ENROLLMENT SERVICE IS ONLY AVAILABLE TO LICENSED PROVIDERS & THOSE FOR WHOM LICENSURE IS REQUIRED BY THEIR STATE

ABOUT PROVIDER ENROLLMENT

GET ENROLLED AS A PROVIDER

MEDICAID PROVIDER ENROLLMENT

What You Get:

MEDICARE PROVIDER ENROLLMENT

What You Get:

PRIVATE PAYER/ INSURANCE ENROLLMENT

What You Get:

ACHC ACCREDITATION

What You Get:

THE JOINT COMMISSION ACCREDITATION

What You Get:

Contact Us

To Get Started: Call: (302) 888-9172

PROVIDER TYPES

ABOUT WAIVER GROUP

CONTACT US

RESOURCES

PRIVATE PAYER/
INSURANCE ENROLLMENT

To Get Started:
Call: (302) 888-9172