Maximize Revenue with Streamlined Medical Credentialing Services

Credentialing involves extensive documentation and verification to join an insurance network. Even a small error or missing form can delay enrollment, leading to significant revenue loss by restricting access to that network’s patients.

MaxGain is the leading provider of medical credentialing services in the US. We simplify the credentialing and enrollment process, allowing you to focus on your core mission. Our experts efficiently manage all credentialing tasks, from primary source verification to premium network enrollment.

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Our Complete Medical Credentialing Services

Since 2012, MaxGain has assisted healthcare providers in speeding up credentialing and enrollment processes. With a proven 95% success rate, we ensure efficient completion of medical credentialing, saving you time and reducing administrative burdens. Our comprehensive suite of physician credentialing services caters to specialties of all sizes.

MCR DMEPOS Registration

Enrollment in the Medicare DMEPOS program, known as Medicare Carrier Request for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (MCR DMEPOS), is necessary to offer and bill Medicare for these specific products and services.

Our medical credentialing services assist you in enrolling in the Medicare DMEPOS program, enhancing the quality of care and facilitating reimbursement from Medicare.

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Commercial Insurance Network Credentialing

Credentialing with commercial insurance payers can be time-consuming due to diverse eligibility criteria and complex plans. It may take several months before you can treat their patients, so we eliminate delays caused by missing information.

Our skilled team collects and arranges all necessary documentation, such as licenses, certifications, and training records. We guarantee your credentialing with major commercial insurance payers like Humana, Cigna, and Aetna.

Revalidation and Credential Renewal

Revalidation and re-credentialing are necessary periodically to maintain compliance and active status with payers. Typically, revalidation occurs every five years, while re-credentialing is needed every three years.

Our physician credentialing services streamline the revalidation and re-credentialing process with Medicare, Medicaid, and commercial insurers. We proactively update your practice demographics, such as location and contact information, to prevent delays or penalties.

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CAQH Registration and Maintenance

Our credentialing specialists handle the registration and upkeep of your provider’s profile on the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal, previously known as CAQH ProView. This simplifies the credentialing process across various health plans.

Medicare and Medicaid Provider Enrollment

We assist healthcare providers to enroll in Medicaid and Medicare, which are the largest insurance programs in the United States. This leads to a wider patient base and, potentially, a lot more revenue for their practices..

NPI Registration (Type 1 and Type 2)

Our healthcare credentialing services help individual providers (Type 1) and organizations (Type 2) obtain or update their National Provider Identifier (NPI). This makes it easier for them to send HIPAA-compliant bills and claims electronically.

Hospital Privileges

We help healthcare providers get hospital privileges, which allow them to admit and treat patients at affiliated hospitals. As a result, they can work with other healthcare professionals and expand their scope of practice.

Medicare and Medicaid Provider Enrollment

We assist healthcare providers to enroll in Medicaid and Medicare, which are the largest insurance programs in the United States. This leads to a wider patient base and, potentially, a lot more revenue for their practices..

NPI Registration (Type 1 and Type 2)

Our healthcare credentialing services help individual providers (Type 1) and organizations (Type 2) obtain or update their National Provider Identifier (NPI). This makes it easier for them to send HIPAA-compliant bills and claims electronically.

Hospital Privileges

We help healthcare providers get hospital privileges, which allow them to admit and treat patients at affiliated hospitals. As a result, they can work with other healthcare professionals and expand their scope of practice.

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DEA Certificate & Renewal

All eligible practitioners authorized to write controlled substance prescriptions are required to possess a federal Drug Enforcement Administration (DEA) certificate.

Within our healthcare credentialing services, we manage the application and renewal procedures for DEA certificates. This ensures healthcare providers can prescribe and manage controlled substances in alignment with their specialties.

CLIA Registration

Healthcare providers and laboratories conducting tests for disease diagnosis, prevention, or treatment must be registered in compliance with the Clinical Laboratory Improvement Amendments (CLIA).

Our services support healthcare providers in navigating the CLIA registration process, allowing them to offer essential testing services to patients.

Frequently Asked Questions

The necessary documents vary depending on the insurance plan and the type of physician/practitioner. The following is a list of some fundamental documents that are typically needed:

Personal documents:

  • Current CV (including current employer, with all entries in mm/yy format)
  • DEA (federal) and state Controlled Dangerous Substances (CDS) certificates
  • Malpractice Insurance (Certificate of Insurance)
  • Current driver’s license
  • Board Certification(s)
  • Practitioner License(s)
  • Diploma or a copy of the highest level of education (required for non-MDs and DOs)

Additional required documents:

  • Collaborative Agreement (required for Nurse Practitioners)
  • ECFMG Certificate (if the provider was educated outside the US)
  • Letter of Admitting Arrangement (required for providers who do not have hospital admitting privileges)
  • Passport or other citizenship documents (if the provider was born outside the United States and has not previously enrolled with Medicare)
  • Letter of Prescribing Arrangement for a physician who does not hold a DEA certificate.

Documents required for your legal entity:

  • IRS Form CP575 or substitute letter 147C (EIN verification)
  • IRS Form W-9
  • CLIA Certificate
  • Copy of office lease (required for therapy facilities)
  • Business License
  • Verification letter of bank account (for Medicare enrollment)

MaxGain enrollment for regular providers takes 2-3 months but allows retroactive billing. Note that this period can vary from state to state. For DMEPOS suppliers, expect a longer wait due to stricter confirmation, including a site visit.

CP575 is an IRS notice that confirms your business’s Employer Identification Number (EIN). It’s basically a confirmation letter saying your business tax ID application was successful.

This letter serves as additional verification of the business’s legal name and must be submitted with the Medicare enrollment application. If the original is unavailable, a replacement letter (147C) can be requested as proof of the EIN. Medicare accepts only these two documents as proof of the EIN.

The specific MaxGain application used for provider enrollment depends on the type of provider enrolling. Here’s a breakdown:

  • Physicians and Non-Physician Practitioners: CMS-855I
  • Group Practices, Clinics, and Certain Other Suppliers: CMS-855B
  • Institutional Providers: CMS-855A
  • Ordering and Certifying Physicians and Non-Physician Practitioners: CMS-855O
  • DMEPOS Suppliers: CMS-855S (This form might be undergoing revisions)

In most cases, yes, providers must have a service location to begin credentialing for MaxGain. Providers cannot use their home address as a clinic address, either permanently or temporarily.

While some exceptions might exist, a home address can be used for billing and correspondence, as long as a physical business address is also provided. This works even if the office is still under construction. The application can be submitted up to 30 days before the location opens for patients. Most commercial carriers have the same policies.