Survey scheduling delays
Certification surveys can take months to schedule. Agencies that are not survey-ready when the window opens lose the slot.
Provider credentialing
Home Health and Hospice Agency Credentialing
Home health agencies and hospices enroll with Medicare as institutional providers, which means state licensure, Medicare certification through a survey, a CMS-855A application and, for home health, capitalization requirements. We manage the sequence and the managed care contracts that follow.
- Institutional enrollment via CMS-855A
- State license and certification survey
- Capitalization proof for home health
- Managed care contracts separate
- Timeline: 9 to 18 months for a new agency
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
Agency enrollment is the most involved provider enrollment Medicare runs. A new home health agency must be licensed by the state, demonstrate initial reserve operating funds, pass a certification survey by the state agency or an accrediting organization, and submit the CMS-855A with ownership disclosures. Hospices follow a similar path with their own conditions of participation. Medicare Advantage and Medicaid managed care plans then contract separately, and their share of home health and hospice volume keeps growing.
ClainetRCM manages agency enrollment from licensure through certification and 855A approval, and then credentials the agency with Medicare Advantage, Medicaid and commercial plans so referrals from every payer are billable.
Where this usually goes wrong
Ownership disclosure errors
The 855A requires complete ownership and managing control disclosures. Errors or omissions trigger development and can raise program integrity concerns.
Managed care contracts assumed
Medicare certification does not put an agency in network with Medicare Advantage plans, and MA plans are the fastest growing referral source. Each requires its own contract.
What ClainetRCM handles for you
One coordinator owns every file from intake to effective date.
- State home health or hospice licensure application and readiness
- Initial reserve operating funds documentation for home health agencies
- Certification survey preparation with the state agency or an accrediting organization
- CMS-855A preparation with ownership, managing control and adverse action disclosures
- Medicare Advantage, Medicaid and commercial plan contracting for the agency
- Clinician and physician onboarding, revalidation tracking and change of ownership filings
Agency enrollment sequence
Entity, NPI and state license
Organization formed, Type 2 NPI issued, state license obtained. See business registrations.
CMS-855A submission
Filed with the MAC before survey; includes capitalization proof for home health.
Certification survey
State survey or accreditation survey against the conditions of participation.
Approval and tie-in
CMS regional office approval, provider number issued, effective date set.
Managed care contracts
Medicare Advantage and Medicaid plans contracted separately. See Medicare Advantage credentialing.
How the work runs
- 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.
Frequently asked questions
From license to Medicare approval, typically nine to eighteen months, driven by survey scheduling and 855A processing. Hospice timelines are similar. Managed care contracting runs in parallel once certification is expected.
New home health agencies must prove initial reserve operating funds sufficient to operate for the first months, calculated per CMS methodology. We prepare the documentation the MAC requires.
Clinician services are billed under the agency, so individual payer credentialing is not required. Agencies must still verify licenses and run background checks as conditions of participation, which we support.
Yes. A change of ownership requires an 855A CHOW filing with strict timelines, and can affect the provider agreement. We manage the filing and the payer notifications. See PECOS enrollment.
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.