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Format: On-Demand Webinar
Presenter: Yesenia Servin, CPMSM, PESC
Time: You can access the webinar anytime
Duration: 60 minutes
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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. During enrollment and credentialing processes both government and commercial payers use your CAQH profile. Complying with the 2024 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 (i.e., each incorrect directory listing).

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 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
  • Discuss delegated and non-delegated agreements with payer networks and how that impacts the use of the Groups module for your practice
  • Step by step guide to successfully incorporating this module into your enrollment process

Areas Covered in the Session

  • CAQH Provider Data Portal
  • Groups: Delegated and Non-Delegated or Both?
  • CAQH Groups Process
  • Navigating CAQH Portal Menu
    • Group Details
    • Legal Business Name
    • Group Contact
    • Corporate Address
    • EIN/ TIN – Only 1 per Group
    • Group NPI
    • Medicaid IDs
    • Medicare IDs
    • Our Team
    • Full Name
    • Role
    • Email
    • Status
    • Logged status
    • Our Practice Locations
    • Practice Name
    • Address
    • Location ID
    • TIN/ EIN – must match the group
    • Group NPI (type 2)
    • Phone Number
    • Providers
    • View Providers Associated with Group
    • Add Providers (via roster only)
    • Our Group
    • Our Locations
    • Our Providers
  • Provider Roster – Non-Delegated
  • Provider Roster – Delegated
  • Provider Authorization
  • Provider Status
  • Assign Providers to The Practice Locations
  • Our Plans – Delegated only
  • Plan Authorization
  • Manage Plans

Suggested Attendees

  • Credentialing Specialist
  • Revenue Cycle Managers
  • Enrollment Specialist
  • Hospitals
  • Mental Health Providers
  • LCPC
  • LMFT
  • Practice, Clinic Owners
  • Hospital Leadership
  • Authorized Officials
  • Delegated Officials
  • Revenue Cycle Directors
  • Credentialing
  • Office Manager
  • Revenue Cycle
  • Operations
  • Billing Team
  • In and Out of Network Providers
  • Medical Billing Companies
  • Providers Office Staff
  • Physician
  • Hospitals and Facilities
  • Insurance Companies
  • Healthcare Attorneys
  • Executive and Administrators
  • Front Desk
  • Scheduling
  • 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. Guides the credentialing and payer enrollment structure.  Thrives on training and growing administrative, credentialing and enrollment healthcare professionals.

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.

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