Enrolled with Medicare, invisible to MA plans
Practices assume Medicare enrollment covers Medicare Advantage. Claims deny as out of network and patients are told to go elsewhere.
Provider credentialing
Medicare Advantage Credentialing
More than half of Medicare beneficiaries are now in Medicare Advantage plans, and each plan credentials separately from original Medicare. We identify the MA plans with membership in your county and enroll you with each of them.
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
Medicare Advantage at a glance
- Separate from original Medicare
- Each carrier credentials independently
- Prioritized by county membership
- Requires active Medicare enrollment
- Contracts reviewed against Medicare rates
The application path we run for this payer
- 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.
Original Medicare enrollment gets you paid for fee-for-service beneficiaries. It does nothing for the patients in Medicare Advantage plans, who now make up the majority of Medicare enrollment in many counties. Each MA carrier requires its own credentialing and contract, and patients in HMO products cannot see you at all without it.
ClainetRCM starts with a county-level look at MA enrollment to find the plans that matter, then runs the applications in parallel so you are not waiting on one carrier while the others sit untouched.
Where this usually goes wrong
Chasing every plan instead of the right ones
A county may have a dozen MA plans on paper but three that hold nearly all the membership. Applying to all twelve delays the three.
MA rates below Medicare
Some MA contracts pay less than the Medicare fee schedule. Signed without review, they undercut the practice for years.
What ClainetRCM handles
One coordinator owns the file from intake to effective date.
- County-level Medicare Advantage enrollment analysis to prioritize plans
- Medicare enrollment verification, since MA plans require an active PTAN
- Applications with each prioritized MA carrier
- CAQH ProView attestation with each plan authorized
- Contract and fee schedule review against Medicare rates
- Provider IDs and effective dates loaded into billing for each plan
Medicare Advantage carriers we enroll with most
| National carriers | Humana, UnitedHealthcare, Aetna, Cigna |
|---|---|
| Blue plans | Blue Cross Blue Shield and Anthem MA products by state |
| Regional and provider-sponsored | Kaiser, SCAN, Devoted, Alignment, Wellcare and hospital-system plans depending on market |
| Prerequisite | Active Medicare enrollment; see Medicare provider enrollment. |
Questions about Medicare Advantage
Yes. Original Medicare enrollment through PECOS does not enroll you with any MA plan. Each carrier credentials and contracts independently, though most accept CAQH data.
CMS publishes county-level MA enrollment by carrier. We use that data to rank plans by membership in your service area and recommend the ones worth pursuing first.
It follows each carrier's commercial timeline, typically 60 to 120 days. Because plans run in parallel, the whole set usually completes within four months when we start them together.
Contracted rates can be below, at or above the Medicare fee schedule. Non-contracted providers are generally paid at Medicare rates for PPO members. We review every MA contract before signature. See payer contracting.
Other payers and enrollment pages
Back to the provider credentialing overview, or continue with a related page.
Medicare Provider Enrollment Services
CMS-855 applications and PECOS filing
Medicaid Provider Enrollment Services
State Medicaid and MCO enrollment
PECOS Enrollment and Account Management
Medicare's online enrollment system
Medicare Revalidation Services
Cycle revalidation without deactivation
Geriatrics billing
MA-heavy patient populations
Cardiology billing
High Medicare and MA volume
Florida medical billing
Among the highest MA penetration
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.