Effective Credentialing: Complete Guide to Provider Credentialing

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Are you new to credentialing? Has it been a while since you credentialed a provider/mid-level? Maybe you were asked to step into a new position in provider credentialing. If you answered yes to one of these questions, then this webinar is for you! Whether you are brand new to provider/mid-level credentialing or have a few years of experience, the ability to provide Effective Credentialing is the most critical key to provider/mid-level credentialing. During this session, Expert Cati Harris, CBCS, walks you through each step of the entire credentialing process for providers and midlevel providers (PA, NP, Non-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 for a new provider/mid-level?
  • What is the process for Setup/Maintenance/Attestation of CAQH, PECOS
  • What are the required documents for credentialing a provider/mid-level?
  • What are the specific requirements for the collaborative agreements?
  • State licensing requirements for provider/mid-levelsBoard Certification requirements for provider/mid-levels
  • What are the requirements for the (mid-level) supervising physician?
  • What are the credentialing requirements for the (mid-level) supervising physician?
  • How to complete the payer applications for credentialing?
  • How to submit the provider/mid-levels application package to payers?
  • Payer Specific requirements for applications and submission
  • Payer Specific contacts and submission information
  • How to track provider/mid-levels 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?
  • How to bill for a midlevel before credentialing is complete?

Areas Covered in the Session

  • Provider/Mid-Level Documentation Requirements
  • CAQH and PECOS
  • Verification of Provider/Mid-Level documents and licensure
  • Collaborative Agreements
  • Supervising Physician Requirements
  • Payer application requirements
  • State Requirements
  • Payer-specific enrollment information
  • Payer application submission
  • Application tracking
  • Medicare/Medicaid Enrollment
  • Efficient and Timely Communication
  • Billing for a Mid-Level before credentialing approval
  • Contract and Fee Schedule Review
  • Steps to complete once Provider/Mid-Level is approved by the payer
  • Sample forms provided

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, billing, and Provider/Mid-Level Credentialing/Contracting. 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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