Medicare & medicaid

Many physicians believe Medicare to be one of the best forms of insurance to accept, as they tend to pay well and expeditiously. However, Medicare also requires the most difficult credentialing process.

Generally, Medicare requires four applications:

  • 855B—(Group of more than one physician) Establish or change a practice group number.
  • 855I—Establish a physician’s individual number.
  • 855R (To link the physician’s individual and group number together)
  • 588-Electronic Funds Transfer (EFT)
Pitfalls to Avoid:
  • When submitting the 855B form, the name of the practice must match exactly with the name submitted on the practice’s IRS letter, the National Provider Identifier (NPI) letter, and the practice checking account.
  • When you have multiple office locations, each of those addresses must be on file with each health plan. If you send in a claim with an office address that is not in the health plan’s billing system, the claim will either be denied or paid as out-of-network.
  • In most cases, only authorized or delegated officials may report changes to the practice’s Medicare enrollment record.
  • Once a physician’s Medicare number is issued, it must be used within a 12-month period or face deactivation. If deactivated, the 855I form will need to be resubmitted.