2025 CAQH Portal Updates - Credentialing and Reimbursement Simplified

Event Materials (Key Required)

Course Description

If you want to keep your medical practice’s revenue flowing, your provider’s CAQH profile must be in compliance and up to date. You must accurately implement the mandatory New CAQH changes to get your enrollment approved and payor reimbursement flowing in. This all sounds good, but what does CAQH 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.

During enrollment and credentialing processes both government and commercial payers use your CAQH profile. Complying with the CAQH changes is also vital to ensure you comply with the No Surprises Act requirements related to current and accurate provider directory listings. Failure to do so can result in heavy penalties violation.

This session will review a step by step each and every section in CAQH. Credentialing and Enrollment specialists are to comply with all the implemented CAQH updates to avoid negative revenue impacts. Implement a solid process for maintaining your CAQH provider accounts and understand how to partner with your practitioners to be fully compliant and structured. Review attestation requirements to speed your re-credentialing turnaround time and create an internal process to easily track CAQH attestations and maintenance.

Learning Objectives

• Know how you should implement the new 2025 CAQH updates
• Identify if new CAQH Profile/ Module implementation is necessary for your medical practices or not
• Pinpoint the data fields & profile sections that will improve your enrollment process
• Review the CAQH process connection to the billing claims submission & reimbursements
• Know the new rules and guidelines for CAQH
• Know how to maintain your CAQH provider accounts compliantly
• Review attestation requirements to speed your re-credentialing turnaround time
• Review CAQH Groups module
• Step by step guide to successfully incorporating this module into your enrollment process
• Review CAQH Proview & Groups module
• Discuss delegated and non-delegated agreements with payer networks and how that impacts the use of the Groups module for your practice
• Guide to successfully incorporating CAQH module into your enrollment process

Areas Covered in the Session

• CAQH Provider Data Portal Overview
• Step by Step Navigation of CAQH Provider Data Portal
• Primary Credentialing Contact
• Groups: Delegated and Non-Delegated or Both
• Delegated Agreement
• Non-Delegated Agreement
• Both (Hybrid) - a combination of the above, payer dictated
• CAQH Group Process
• Maintaining Group Section
• Group Details
• Legal Business Name
• Group Contact
• Corporate Address
• EIN/TIN - only 1 per group
• Group NPI - you can have multiple
• Medicaid IDs
• Medicare IDs
• Assign Providers to the practice locations
• Provider Authorization
• Provider Status
• Our Plans - Delegated only
• Our Plans, Add Plans - Delegated only
• Plan Authorization

Suggested Attendees

• Credentialing Specialist
• Enrollment Specialist 
• Hospitals and Providers
• Executive and Administrators
• Practice and Clinic Owners
• Hospital Leadership
• Authorized Officials
• Delegated Officials
• Revenue Cycle Directors
• Office Manager
• Revenue Cycle Staff 
• Operations Staff
• Billing Team
• In and Out of Network Providers
• Medical Billing Companies
• Providers Office Staff
• Hospitals and Facilities
• Mental Health Providers
• LCPCs and LMFTs
• Insurance Companies
• Healthcare Attorneys
• Front Desk Staff 
• Authorizations Staff 
• Medical Assistants
• Certified Nursing Assistants

About the Presenter

Yesenia Servin, CPMSM, PESC, is an expert in credentialing and provider/payer enrollment with over 23 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 for credentialing and payer enrollment structure. Yesenia manages payer enrollment, keeps team members and colleagues up to date on industry trends, and is a liaison to all departments that impact payer-enrollment processes. Yesenia works 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 CharterOak University Faculty, NAMSS member, and is a past NAMSS Educational Conference Guest Speaker, a current member of the NAHRI Leadership Council, current trainer for The Chicago School of Professional Psychology trainer and a TMG Collaborator. Yesenia studied microeconomics and communications at NEIU and healthcare administration at Concordia University Chicago. 

Additional Information

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

Purchase Order Form - Click Here to download PO form. 

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