Credentialing & Enrollment Rules: Physicians & Advanced Practice Providers (APPs) Credentialing

Event Materials (Key Required)

Course Description

Are you new to provider/mid-level credentialing? Do you want to implement a proven credentialing system? Do you want to “brush up” on your credentialing skills? If you answered yes, then this webinar is for you! Join expert Cati Harris, CBCS, as she provides you with a comprehensive guide to provider and mid-level credentialing. In this detailed program, you will learn how to setup/maintain CAQH, PECOS, NPPES, I&A, Provider/ Mid-Level credentialing documentation requirements, verification of Provider/ Mid-Level documents, Payor application requirements, and the preparation/submission of payer credentialing applications packages.

You will be provided proven tracking tools to aid in provider document tracking/ verification, and payer application tracking. A set of over 10 various, fully customizable forms, letters, etc for provider documentation requirements, CV requirements, application submission, provider/ mid level linking, re-validation, and employment history requirements. Lastly, there will be a live question/ answer session at the end of the presentation.

Once you complete this session, you will have the detailed information you need to successfully begin credentialing providers/ mid-levels. 

Learning Objectives

• When is it possible to start credentialing for a new physician?
• What is the process for Setup/Maintenance/ Attestation of CAQH, PECOS/ NPPES
• 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/active. 
• How to track submitted payer application packages.
• Common processing times and how to identify flagged applications.
• Tips to ensure your credentialing process are efficient and timely.
• 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

• 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
• 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 Provider Credentialing and Contracting with Solor Inc., a third-party billing company providing physicians across all specialties full-service revenue cycle management, billing, and credentialing. Cati’s expertise extends through managing credentialing services, implementing successful enrollment programs, and contract/fee schedule negotiations for providers with all major payers. 

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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