2023 CAQH Rule Changes: Avoid Reimbursement Delays

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There are a lot of misconceptions among medical providers as to what exactly CAQH is and what it will do for a provider. CAQH stands for The Council for Affordable Quality Healthcare and is a nonprofit alliance of health plans and trade associations, working to simplify healthcare administration through industry collaboration on public-private initiatives. CAQH aims to reduce the administrative burden for providers and health plans.

This all sounds good, but what does it actually do and how does it reduce this burden? Well anyone who has done credentialing in any form for a provider knows that the credentialing process is not easy. Each insurance carrier has their own forms and their own process that a provider must follow to join the network for that carrier. During this webinar, participants will learn how to identify and comply with all the implemented CAQH updates to avoid negative revenue impacts; and also know how to reduce payer claims holds and rejections due to inaccurate profile details.

Learning Objective:

  • Year in Review: CAQH updates
  • CAQH – what is next, what to expect, how to advocate
  • Implement the updates – best practices
  • Implement a solid process for maintaining your CAQH provider accounts and Practice Manager CAQH account.
  • Review attestation requirements to speed your re-credentialing turnaround time and create an internal process to more easily track CAQH attestations and maintenance

Areas Covered in the Session

  • CAQH Updates
  • CAQH – what is next, what to expect, how to advocate
  • Best Practices for Implementation
  • CAQH Proview – Provider Profile
  • CAQH Practice Manager – Organization Profile
  • CQH Proview for Groups
  • Validate Locations for Errors and Suggested Changes
  • Limit TIN to One for Existing Practice Locations Currently
  • Streamlined credentialing process
  • Demographic and professional provider data administration processes
  • Real-time system validation
  • Provider specialties
  • Healthcare Organizations using CAQH
  • Avoid application delays
  • Impact the CAQH accounts have on your revenue cycle
  • Required professional documentation

Suggested Attendees

  • Credentialing and Enrollment Specialists
  • Credentialing and Enrollment Experts
  • Credentialing and Enrollment Leaders
  • Healthcare Administrative Teams, Personnel
  • Practice Managers
  • Healthcare Billing Specialist
  • Staff Providing NPI support, NPPES  Support
  • PESC, CPMSM, CPCS
  • Staff Providing CAQH Support
  • Clinic Managers
  • Allied Health Providers
  • Advance Health Practitioner
  • Credentialing
  • Enrollment
  • Office Managers
  • Operations
  • Revenue Cycle
  • Coders
  • Clinical Directors
  • Practice Owners
  • Claims Teams
  • MSPs
  • CAQH specialist

About the Presenter

Yesenia Servin is an expert in credentialing and provider/payer enrollment with 22 years of experience in the healthcare industry. Yesenia has a deep understanding of Medicare & Medicaid enrollment and is a nationally certified credentialing manager and provider enrollment specialist. Through, YS Credentialing PLLC, Yesenia

  • Helps organizations develop and implement best practices guidelines and processes
  • Analyzes revenue cycle management
  • Guides the credentialing and payer enrollment structure

Yesenia is the payer enrollment lead with TeamMed Global. She manages payer enrollment, keeps team members up to date on industry trends, and is a liaison to all departments that impact payer-enrollment processes. In previous positions, Yesenia has worked with durable medical equipment, hospital and health systems, community mental health organizations, and global managed care organizations as well as providing revenue cycle consulting services to various healthcare providers and organizations.

Yesenia is a current Team Med Global Lead Collaborator, Team Med Global University Faculty, NAMSS member, and is a current and past NAMSS Educational Conference Guest Speaker, a current member of the NAHRI Leadership Council, current trainer for The Chicago School of Professional Psychology and industry trainer. Yesenia studied microeconomics and communications at NEIU and is currently studying healthcare administration at Concordia University Chicago.

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
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  • Course Key
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