What Do I Need to Become a Medicaid Provider?
Medicaid providers serve low-income families, pregnant women and children under 18 years old. Each state maintains a Medicaid division that screens eligible recipients and providers. By getting approved as an authorized Medicaid provider, you will receive payment from the government for qualified care. The government predetermines acceptable treatments and fees just like private insurance companies.
Basics
Start by determining whether your services are authorized. Medicaid providers include pediatricians, dentists, home health care agencies and medical equipment suppliers. However, it's unlikely you will be accepted if you perform only cosmetic treatments such as face-lifts or botox injections. Obtain an enrollment application from a local Medicaid office or online. Most agencies provide vast information through their websites.
Provider requirement, such as applications, fees and restrictions, vary by state. For example, in Florida, you must complete a Medicaid Provider Application. Most states require that you disclose the company's full legal name or "doing business as" name if you are a sole proprietor (Dr. John James DBA John James Clinic). Also provide contact information, such as the company's mailing address, telephone number, contact person and tax identification number (social security or employer identification number).
Disclosures
The government requires providers to explain ownership structures. For example, if you own a clinic with three other physicians, each person will identify himself and complete a fingerprint card for a background check. Provide a state identification or facility number when registering a health agency, such as a clinic or nursing home, and your license number when registering as a professional, such as a doctor, dentist or nurse.
You must obtain appropriate codes to identify your services. For instance, provider type 65, practice type 30 or 99, and category of service 65 or 90 refer to home health agencies in Florida. Medicaid provider requirements differ depending on practice or service. Florida requires proof of board certification for physicians who specialize in pediatric surgery or urology.
Another important detail involves compensation. You must disclose the method you will use to submit claims, such as billing agents or vendor software. If you want to get reimbursed electronically, supply bank account information.
Considerations
Remember to answer application questions truthfully. Some key questions involve criminal records and disciplinary actions. Providing false information violates state and federal laws.
Do not perform services for Medicaid clients until you receive status as an authorized provider. For example, if your pharmacy has a pending application, refer Medicaid recipients to other providers.
Promptly respond to any notices or inquiries, such as those to clarify treatment or billing, so that you do not jeopardize your provider status.
Tags: Medicaid Provider, authorized Medicaid, Become Medicaid, Become Medicaid Provider, home health, identification number