CREDENTIALING
MEDEX specializes in completing enrollment forms and applications for physicians, mid level providers, medical groups and clinics throughout the state. Based on our experience, all initial credentialing submission work will be completed within a 2-4 week period, after receiving the requested information contained on our credentialing checklist. We anticipate effective dates within 30-120 days based on the carrier’s internal process and time frame. MEDEX will provide a credentialing status update via email every few weeks or as new plans are approved. Many of our clients are particularly concerned about completing their Medicare and Medi-Cal forms correctly the first time. This is critical as you do not want to miss reimbursement during the initial start-up months of your practice.
The key applications for Medicare and Medi-Cal are as follows:
| Medicare | |
| Individual | Group |
|
855I – Enrollment Application 460 – Participating Physician Agreement 588 – Electronic Funds Transfer Form |
855 B – Group Form 588 – Group Form 855I – For All Physicians in Group 855R – For All Physicians in Group 460 – For All Physicians in Group |
| Medi-Cal | |
| Individual | Group |
|
6210 – Application 6207 – Disclosure Statement |
6203 – Group Application 6207 – Medi-Cal Disclosure Statement 6208 – Medi-Cal Provider Agreement 6210 – Medi-Cal physician Application 6216 – Rendering Provider Application |
Other Common Insurance Carriers
Council for Affordable Quality Healthcare (CAQH) – This central data base is used by many health plans to verify physician credentialing information. Health plans that use CAQH include: Aetna, Beech Street, Anthem Blue Cross, Cigna, Coventry, Health Net, Great West, Humana, Pacific Care/UHC, and Multi-Plan.
In addition to these core plans, each community/region may have a number of Independent Physicians Associations (IPAs) that contract with various managed care plans as well as other programs unique to each community.
Credentialing Documents
Following are the documents required to initiate credentialing:
Credentialing Checklist
California Participating Physician Application (CPPA)
CPPA Addendum A
CPPA Addendum B
CPPA Signature Pages
CAQH Questionnaire
CAQH Signature Page
Individual Medicare Signature Pages
Medi-Cal Signature Pages 6210 & 6207
Worker's Compensation Questionnaire
W-9
