Private Insurance & MCO Enrollment

Enrolling with private payers and Managed Care Organizations (MCOs) is essential for expanding your patient base and revenue streams. However, the process can be time-consuming and confusing.

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What We Do:

✅ Identify & Apply to Private Payers & MCOs
We identify the best private payers and MCOs for your practice and manage the entire application process.

✅ Contract Negotiation & Credentialing
We negotiate favorable contract terms and ensure your credentials are verified by payers.

✅ Insurance Paneling & Billing Setup
Once credentialed, we assist with paneling and billing setup to ensure you can start receiving payments immediately.

✅ Recredentialing & Compliance Assistance
Private payers require periodic recredentialing. We handle this process to ensure continuous eligibility.

📌 Major MCOs & Private Insurers We Work With
We assist with enrollment for major MCOs and private insurers nationwide, including:

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UnitedHealthcare

• Overview :
  UnitedHealthcare is one of the largest health insurers in the U.S. and operates as part of UnitedHealth Group. It serves Medicaid, Medicare Advantage, and commercial populations.

• States Covered :
  Operates in nearly all 50 states, with significant Medicaid and Medicare Advantage footprints.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

  • Dual Eligible Special Needs Plans (D-SNPs)

Anthem (Elevance Health)

• Overview :
  Anthem, now rebranded as Elevance Health, is a major player in the managed care space. It operates under various brand names depending on the state (e.g., Anthem Blue Cross, Empire BlueCross BlueShield).

• States Covered :
  Active in over 40 states, including large Medicaid and Medicare Advantage programs.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

  • Commercial Insurance

Centene Corporation

• Overview :
  Centene is a leading Medicaid-focused MCO and also serves Medicare Advantage and commercial populations. It has expanded rapidly through acquisitions.

• States Covered :
  Operates in nearly all states, with a strong focus on Medicaid and dual-eligible populations.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

  • Marketplace Exchange Plans

Humana

• Overview :
  Humana is a Fortune 50 company with a strong focus on Medicare Advantage and dual-eligible populations. It also offers Medicaid managed care in select states.

• States Covered :
  Operates in over 40 states, with a dominant presence in Medicare Advantage.

• Key Programs :

  • Medicare Advantage

  • Dual Eligible Special Needs Plans (D-SNPs)

  • Medicaid Managed Care

Aetna (a CVS Health Company)

• Overview :
  Aetna is a major insurer offering Medicaid, Medicare Advantage, and commercial plans. It was acquired by CVS Health in 2018, further expanding its reach.

• States Covered :
  Operates in over 40 states, with significant Medicaid and Medicare Advantage programs.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

  • Commercial Insurance

Cigna

• Overview :
  Cigna is a global health services organization that provides Medicaid, Medicare Advantage, and commercial insurance. While it is more prominent in commercial markets, it has expanded into government programs.

• States Covered :
  Operates in over 30 states, with growing Medicaid and Medicare Advantage programs.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

  • Commercial Insurance

Molina Healthcare

• Overview :
  Molina Healthcare specializes in serving low-income populations through Medicaid and Medicare Advantage programs. It has a strong presence in underserved communities.

• States Covered :
  Operates in over 15 states, but its Medicaid focus makes it a key player in those markets.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

WellCare (Part of Centene Corporation)

• Overview :
  WellCare was acquired by Centene in 2020 and remains a significant brand for Medicaid and Medicare Advantage programs.

• States Covered :
  Operates in over 30 states, with a focus on government-sponsored programs.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

  • Dual Eligible Special Needs Plans (D-SNPs)

Kaiser Permanente

• Overview :
  Kaiser Permanente is a vertically integrated healthcare system that combines insurance and provider services. While it is not present in all states, it operates in key regions with large populations.

• States Covered :
  Operates in 8 states and Washington, D.C., with a strong focus on Medicaid and Medicare Advantage.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

Blue Cross Blue Shield Association (BCBSA)

• Overview :
  The Blue Cross Blue Shield Association is a network of independent, locally operated BCBS plans. Collectively, BCBS plans operate in all 50 states.

• States Covered :
  Every state has at least one BCBS plan, making it a truly national presence.

• Key Programs :

  • Medicaid Managed Care

  • Medicare Advantage

  • Commercial Insurance

Other Notable MCOs

• Magellan Health: Focuses on behavioral health and specialty health services, operating in multiple states.

• CareSource: A Medicaid-focused MCO with operations in several states.

• AmeriHealth Caritas: Operates Medicaid and Medicare Advantage programs in multiple states.

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📌 Why Choose Us for Private Insurance & MCO Enrollment?

• Broad Network Access: We help you enroll with multiple payers simultaneously.

• Negotiation Expertise: We secure the best possible rates for your services.

• Ongoing Support: We monitor deadlines and handle recredentialing to keep you compliant.

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