Mastering Payor Enrollment Platforms – CAQH, PECOS, NPPES and I&A

Course Description

Not understanding where or how to get started with enrolling your organization’s providers is the first step and signal to get to know the tools widely used in the industry for Commercial and Governmental payers. Both PECOS and CAQH are the main tools for enrolling multiple types of providers into your Commercial plans and Medicare. Knowing how to set your organization up within each of the portals is fundamental to keeping your providers on target with enrollment and continuous monitoring. This informative session will dive into each of the system tools to explain best practice setups and methods for easy usage and implementation. 

Learning Outcomes

• Identify the widely used tools within the Payer Enrollment and Commercial Payer industry (CAQH, PECOS)
• Learn the purpose and functions of CAQH in the payer enrollment industry
• Understand the Medicare ecosphere for Provider Enrollment
• Understand the functions of the Identify & Access system
• Understand the functions of the NPPES system and its importance to Credentialing & Payer Enrollment
• Learn the differences between the three systems and how each of them interacts with each other
• Explain some of the best practice workflows to implement from a paper to electronic process using PECOS and CAQH        

Areas Covered in the Session:

• I&A, PECOS and NPPES relationships – Setting up your organization
• Medical Staff Role
  • Initial Enrollment
  • Revalidation
  • Changes of Information (CHOI & CHOW)
  • Setting up Provider record or the Organizational record
  • Ensuring continued compliance with Medicare Program
• POCOS, I&A & NPPES Relationship
• Access Levels (Authorized, Designated and Surrogacy)
• Enrollment - Process for Providers & Groups
• CHOIs and CHOWs – Compliance Fundamentals and Best Practices
• Telemedicine Fundamentals for Enrollment (Distant/Originating Sites)
• Access Roles for Enrollments
• What is needed for enrollment?
  • Sole Proprietors, Individual Physician & Non-Physicians
  • Provider or Supplier Organizations
  • Requesting Access
• Linked to PECOS Records
• Enrollments
• Starting Application
• PAR Status Information & Special Payments address
• Reassignment Information
• Organizational Control
• Individual Control
• Submission of Application
• Revalidation
• Telemedicine
• CAQH
• What are the benefits of CAQH
• Who uses CAQH?
• Getting Started with CAQH
• Maintaining Provider Profiles
• Information needed to complete application
• Documents needed to complete application
• Intake Process
• Documentation
• Organizing CAQH for your Organization
• Organizational Module (Practice Manager)
• Live Q&A Session

Suggested Attendees:

• Payor Enrollment Specialists
• Credentialing Specialists & Coordinators
• Medical Staff Leadership
• Revenue Cycle Leadership
• Managed Care Enrollment Coordinators & Specialists
• CPCS, CPMSM Certified individuals
• Credentialing and Enrollment Specialists, Experts & Leaders
• Healthcare Administrative Teams
• Practice Managers
• Healthcare Billing Specialist
• Staff Providing NPI Support, NPPES  Support
• Staff Providing CAQH Support
• Clinic Managers
• Allied Health Providers
• Advance Health Practitioner
• Office Managers
• Operations
• Coders
• Clinical Directors
• Practice Owners
• Claims Teams
• MSPs

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About the Presenter:

Larry DeHoyos, CPCS, PESC, is a thought leader and innovator with more than 24 years working experience as a Medical Staff Professional. He is nationally certified as a Provider Credentialing Specialist and also holds certificates in Provider Enrollment and as a Transformational Healthcare Champion. His expertise spans all 50 states within a multitude of healthcare spaces including Health Plan, Managed/Specialty Care, Outpatient/Surgical spaces, Laboratories and most recently within a Healthcare Staffing Agency as Director of Credentialing for a per diem staff network of over 32,000 nursing professionals. Larry’s knowledge and experience sets his intent outside of the bounds of the industry and focuses on helping organizations solve challenges in process, technology and compliance within Credentialing, Provider Enrollment, Revenue Cycle and Accreditation Readiness. He is an active member with the National Association of Medical Staff Services and state and local chapters for California, Massachusetts and Texas. He has spoken on various industry topics for platforms as McKnight’s Long Term Care News, NAMSS, National Provider Enrollment Forum, and various State and Local Associations of NAMSS.

Additional Information

Snippets From Our Previous Session