Successful Payer Credentialing & Enrollment for Multi-Location Practice

  • Course level: All Levels
  • Duration 1h
  • Last Update February 2, 2022

Description

This intermediate presentation will provide training and guidance on creating a successful payer credentialing & enrollment process. The presenter will go over crucial steps including credentialing, provider enrollment, billing, and revenue cycle management. Providers will understand how to create an efficient credentialing/enrollment process. Review how these processes impact claims submissions and receive claims reimbursement from different payers. During this workshop, providers will understand CAQH, NPPES, I&A, Availity, ERA and EFTs, and the Medicare portal.

Licensing and credentialing telehealth providers can pose challenges to expanding telehealth programs in rural communities. Licensing and credentialing are intended to protect patients by ensuring that telehealth providers are in compliance with state regulations and hospital policies. With COVID-19, there are many struggling hospitals, physician deficiencies, and insufficient access to healthcare providers. Many healthcare facilities invest more time, money, and resources into upgrading their telehealth offerings to neutralize these shortages.

Areas Covered in the Session:

  1. Organizations with Payer “Delegated Agreements” (Typically there is a provider limit of 300 & up, based on payer)
    • Credentialing Process
    • Enrollment Process
      1. Multiple Locations
      2. Multiple NPIs
      3. Multiple Tax IDs
      4. Government Payers
      5. Commercial Payers
    • Provider Account Management
      1. CAQH
      2. I&A, NPPES
      3. PECOS
  2. Organizations that do not hold Payer “Delegated Agreements”
    • Credentialing Process
    • Enrollment Process
      1. Multiple Locations
      2. Multiple NPIs
      3. Multiple Tax IDs
      4. Government Payers
      5. Commercial Payers
    • Provider Account Management
      1. CAQH
      2. I&A, NPPES
      3. PECOS
  3. Additional credentialing & enrollment process to review
    • Multiple Locations
    • Multiple NPIs
    • Multiple Tax IDs

What Will I Learn?

  • Review the enrollment process for the multi-practice, multi-NPI organization to meet compliance
  • Review process enrollment process that collaborates with the revenue cycle management
  • Determine if your organization is set up for network delegated agreements vs individual provider applications
  • Set strong enrollment process to ease internal misses
  • Know state by state licensure requirements

Topics for this course

1 Lessons1h

You can access all the webinar materials after successful payment

Webinar Link + Handouts PDF

About the instructor

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, and community mental health organizations, 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.

Yesenia enjoys spending time with her family and pugs. She finds great joy in jumping in the mini-van for a family road trip.

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5 Courses

20 students

$251.00

Material Includes

  • Handouts PDF
  • Full Webinar Video with unlimited access

Requirements

  • System Requirement Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
  • Internet Speed: Preferably above 1 MBPS
  • Headset: Any decent headset and microphone which can be used to talk and hear clearly

Target Audience

  • PESC, CPMSM, CPCS
  • Credentialing
  • Enrollment.
  • Office Managers
  • Operations
  • Revenue Cycle
  • Coders
  • Clinical Directors
  • Practice Owners
  • Claims Teams
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