Sometimes there is a need to launch enrollment processes with HMO plans while your Medicaid fee-for-service application is still pending. Unfortunately, our experience shows that delays in application processing for Medicaid enrollment are quite frequent regardless of a provider’s state. To secure at least a small portion of practice revenue, some providers may wish to submit their participation applications to HMO plans to start accepting more patients.
If your Medicaid application is pending for more than 30 days, you can start applying for such plans. HMO will look into the pending list of providers at Medicaid and make a consideration.
Managed Care Organizations (MCO’s) must ensure that during the initial credentialing of providers new to the network, the Active and Pending Enrollment files are checked to verify enrollment in fee-for-service Medicaid. Pended providers should be allowed provisional credentialing for 120 days while the Department of Health makes its enrollment decision.
Make sure that your Medicaid enrollment application will not be denied or rejected due to errors or other reasons, as it may cause problems with HMOs-approved enrollments or may lead to application rejections from HMOs.
But why would you handle it on your own? Trust your insurance contracts to the professionals!
At WCH Service Bureau, we have over 20 years of experience in dealing with complex enrollment cases for hundreds of payers all over the country. Contact us.
