Credentialing Physician – Understanding Complete Process to Eliminate Reimbursement Delays

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About Course

When onboarding a new physician to your practice, the slightest mistake can result in significant reimbursement delays and rejection of your provider credentialing application package. To get your new provider fully credentialed and contracted with payers, there are specific requirements, documents, and payer-specific requirements you must have right the first time. Failure to do so can impact your provider/practice revenue and greatly affect patient care. Even simple errors can get your set-up/transfer documents rejected by the payer leading to you starting the entire process over. It is important that your new physician starts to see patients and get paid as soon as possible.

During this session, Expert Cati Harris, CBCS, walks you through each step of the entire credentialing process for physicians. You will learn documentation requirements, application requirements, payer-specific requirements, document, and application package prep, credentialing package submission, setup and maintenance of CAQH, PECOS, tracking of applications submitted to payers, and final steps once approval has been received. This will also include a review of provider revalidations. You will also learn how you can make your onboarding process more efficient and accurate to speed up your billing process and get paid more quickly.

Learning Objective:

  • When is it possible to start credentialing a new physician?
  • What is the process for Setup/Maintenance/Attestation of CAQH, and PECOS?
  • What are the required documents for credentialing a provider?
  • How to complete the payer applications for credentialing?
  • How to submit the provider application package to payers?
  • Payer Specific requirements for applications and submission.
  • Payer Specific contact and submission information
  • How to track provider documentation and verify authenticity/activity?
  • How to track submitted payer application packages?
  • Common processing times and how to identify flagged applications.
  • Tips to ensure your credentialing process is efficient and timely.
  • The process to complete once the payer has approved credentialing
  • How to review the proposed Fee Schedule and Contracts?
  • How to efficiently communicate updates with the payer and provider?

Areas Covered in the Session:

  • Provider Documentation Requirements
  • CAQH and PECOS
  • Verification of provider documents and licensure
  • Payer application requirements
  • State Requirements
  • Payer-specific enrollment information
  • Payer application submission
  • Application tracking
  • Medicare/Medicaid Enrollment
  • Efficient and Timely Communication
  • Contract and Fee Schedule Review
  • Steps to complete once the provider is approved by the payer.
  • Sample forms provided
  • Live Q&A Session

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

Cati Harris, CBCS is a nationally certified credentialing, billing, and coding specialist, with over 20 years of experience in the healthcare industry. Cati is the Director of Credentialing/Contracting with Solor, Inc., a third-party billing company providing physicians across all specialties full-service revenue cycle management and billing. Cati’s expertise extends through managing credentialing services and contract/fee schedule negotiations for providers with all major payers.

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
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