Medicare Advantage plans left out
A cardiology practice enrolled with Medicare but not the top three MA plans in its county is out of network for most of its older patients.
Specialty credentialing program
Cardiology Credentialing Services
Cardiology practices carry the heaviest Medicare and Medicare Advantage exposure of almost any specialty, plus procedure privileges and imaging accreditation that payers and hospitals both check. We credential cardiologists with every payer and coordinate the privileges and accreditations that go with them.
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
- Medicare plus county-level MA plans
- Cath and EP privileges by case log
- Imaging accreditation linked to payers
- Subspecialty designations on every panel
- Typical full timeline: about 5 months
A cardiologist's file includes internal medicine and cardiology board certification, subspecialty certification for interventional or electrophysiology work, hospital privileges for the cath lab or EP lab, and often nuclear or echo laboratory accreditation for in-office imaging. Payers ask about all of it, and Medicare Advantage plans, which dominate the cardiology patient population, each credential separately.
ClainetRCM builds the cardiology file once, credentials the physician and group with Medicare, the MA plans that hold share in your county and every relevant commercial panel, and coordinates hospital privileges so the whole set lands together.
Where this usually goes wrong
Subspecialty privileges delayed
Interventional and EP privileges require case logs and subspecialty certification. Files without them wait for committee questions.
Imaging accreditation not linked
Nuclear cardiology, echo and vascular lab accreditation must be current for payers to reimburse the technical component. Enrollment without it produces imaging denials.
What ClainetRCM handles for you
One coordinator owns every file from intake to effective date.
- Complete file with cardiology and subspecialty board certification, case logs and privileges
- Medicare enrollment and reassignments; county-level Medicare Advantage plan enrollment
- Commercial payer credentialing with cardiology specialty designation
- Hospital privileges for cath lab, EP lab and echo interpretation
- Imaging accreditation coordination (IAC, ACR) tied to payer records
- Device clinic, cardiac rehab and remote monitoring enrollment where the practice offers them
Cardiology credentialing components
Medicare and Medicare Advantage Original Medicare through PECOS plus each MA carrier separately. See Medicare Advantage credentialing.
Hospital privileges Core cardiology plus delineated cath, EP and imaging privileges. See hospital privileging.
Imaging accreditation IAC or ACR accreditation for echo, nuclear and vascular labs; required by most payers for the technical component.
Commercial panels Standard credentialing with cardiology specialty and subspecialty designations. See physician credentialing.
Billing Once enrolled, our cardiology billing program handles diagnostics, devices and global periods.
How the work runs
The sequence is the same for every payer and provider type; what changes is which documents and portals each step touches.
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
After enrollment
Cardiology billing
Diagnostics, devices and global periods. Once your providers are payable, the same team keeps the claims moving.
Frequently asked questions
Medicare 30 to 60 days, MA and commercial plans 90 to 150 days, hospital privileges 90 to 180 days. A cardiologist with a complete file and current case logs is typically fully payable within five months.
The plans with the most enrollment in your county. CMS publishes that data, and we use it to prioritize. In most markets that means Humana, UnitedHealthcare, Aetna and the local Blue plan, plus one or two regional carriers.
Medicare and most commercial payers require accreditation for the technical component of advanced imaging, including nuclear cardiology and echocardiography in many plans. We keep accreditation records linked to payer enrollment.
Yes. Advanced practice providers in cardiology are credentialed individually and linked to the group, with taxonomy reflecting cardiology. See NP credentialing.
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.