Medicare
The contract Group that provides Medicare enrollment services for one region of the country which includes Colorado
What is Novitas?
The contract Group that provides Medicaid enrollment services for Colorado.
Who is Gainwell?
Super Hero trio responsible for employed practitioners enrollment in Government Programs
Who are Guadalupe, Robert and Carrie?
Receiving information directly from the issuing source.
What is Primary Source Verification?
After initial enrollments this activity occurs after 5 years.
What is Revalidation?
A Medicaid product that specializes in serving children in the state of Colorado.
What is CHP?
This Provider Enrollment team member works with practitioners to be compliant when they have a legal name change.
Who is Carrie Halcott?
When requesting information from a third party regarding a practitioner, one must send this form along with the request
What is a Signed Consent and Release form?
This online platform is used by CMS Medicare for enrollment activity.
What is PECOS?
A program that provides medical coverage to residents of Colorado.
What is Medicaid?
This piece of legislation required all NPPSE information to be updated with a digital address.
What is 21st Century Cures Act?
NCQA-required committee that makes recommendations regarding credentialing decisions
What is the Credentialing Committee?
The Governments program to detect and combat improper payment?
What is Waste Fraud and Abuse?
The Colorado State Department that oversees the Health First Colorado and CHP programs.
Who is The Colorado Department of Health Care Policy & Financing?
Recent improvements in resource management include this data element
What is Zip plus 4?
Active, Associate, Courtesy, Honorary, Consulting are all examples of this
What are Membership Categories?
A process by which a practitioner grants approval to a group to enroll on their behalf.
What is Surrogacy?
During the year 2021, the roll out of this process was very difficult
What is Medicaid Revalidation?
This identifying number implemented in 2007 is used to identify practitioners, medical offices, labs etc..
What is the NPI?
The name of the entity that was established through the Health Care Quality Improvement Act of 1986 to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history?
What is the National Practitioner Data Bank?