Learning Objectives

• When is it possible to start credentialing for a provider/mid-level?
• Critical information for beginning the credentialing process
• What are the required documents for credentialing a provider?
• How to Verify/Validate provider documents
• Tracking of Provider Documents
• Setup/Maintenance of the Provider File
• Payer-Specific Enrollment Information
• Setup/Maintenance/Attestation of CAQH, PECOS, NPPES, I&A
• How to complete the payer enrollment applications
• How to submit provider enrollment applications
• Payer Specific requirements for applications and submission.
• Payer Specific contact and submission information
• Tracking of submitted payer enrollment application packages
• Processing times and how to identify flagged applications.
• Effective, Timely Communication for updating application status with providers
• Process to complete once the payer has approved credentialing

Areas Covered in the Session

• Credentialing Keys to Success
  • Research
  • Preparation
  • Tracking
  • Communication
• How do I start the process of credentialing a provider?
• Research
  • Provider Research
  • Payer Research
• Provider Welcome Package Documents
  • Provider Enrollment Information Document
  • Provider Document Checklist
  • Provider CV Requirements
  • Welcome Letter
  • Description of Services
  • Provider Contact Information Sheet
  • CAQH Release and Attestation Form
• Payer Documents
  • Payer/ State Applications
  • Payer Contact Information
  • Tracking Spreadsheet
• Provider Document Preparation
  • Review All Documents for Accuracy, Dates, Infractions
  • Create a Provider File
  • Access Provider Logins
  • Review Provider CV
• National Plan & Provider Enumeration System (NPPES)
• Identity & Access Management System
• Council for Affordable Quality Healthcare (CAQH)
• Provider, Enrollment, Chain & Ownership System (PECOS)
• Payer Document Preparation
• Application Preparation
• Payer Application Submission via Email/ Fax
• Payer Application Submission via Payer Website
• Linking of Provider/ Mid-Level
• Linking a Provider already PAR with the Payer
• Provider Re-Validation
• Tracking
  • Document Tracking
  • Application Tracking
• Provider Document Tracking Tools
  • Provider Document Checklist
  • Excel Tracking Spreadsheet
• Application Tracking
• Communication
• Minimize Impact
• Steps to Minimize Financial Impact
• Next Step after Provider Credentialing is Approved
• Information Storage
• Important Forms & Sheets

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

About the Presenter