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Format: | On-Demand Webinar |
Presenter: | Tammy West, MHA/ED, CPMSM, CPCS |
Time: | You can access the webinar anytime |
Duration: | 60 minutes |
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The payor enrollment process can take six months or longer for commercial payors. It is a time-consuming process that creates barriers to practitioner onboarding and revenue generation. Payor enrollment can delay the onboarding process for months, especially with commercial payors. These delays create issues with provider satisfaction, patient satisfaction, revenue generation, access to care and, ultimately, patient safety.
Delegated credentialing can simplify the enrollment process by allowing health care organizations to accept responsibility for credentialing their own providers. There are several steps involved in becoming delegated with health plans. Organizations must complete a pre-delegation process, including a file audit and review of their policies and procedures in order to become delegated with a payor. Once the organization is delegated, they are able to control the credentialing and approval process for the payor and greatly reduce the timeline for payor credentialing.
This presentation will review how payor enrollment and delegated credentialing affect revenue cycle. Focus will be given to the benefits of delegated credentialing and steps to successfully complete a pre-delegation audit and implement a delegation agreement with payors.
Tammy West is Director Professional Services for The Hardenbergh Group. She brings 25 years of experience in healthcare administration and 16 years in Medical Staff Services. Tammy specializes in CVO operations, provider credentialing, provider enrollment, quality analysis, quality improvement, quality auditing, delegation audits, and policy and procedure creation and implementation. She has extensive experience with CMS, TJC and NCQA requirements for provider credentialing and medical staff services.
Prior to joining The Hardenbergh Group, Tammy was a consultant and independent contractor for hospitals, health systems, CVOs, locum companies and private practices across the United States. She has vast experience as an MSP, including credentialing specialist, provider enrollment specialist, medical staff coordinator, Medical Staff Manager, and CVO Director.
Tammy was a CVO Manager where she was responsible for creating and implementing policies and procedures for a new corporate CVO for a large health system. During her tenure, the CVO achieved NCQA accreditation and delegated credentialing status with commercial payors. Additionally, Tammy worked as a quality auditor for an NCQA certified managed care company and an Adjunct Instructor teaching medical office systems classes.
Tammy has a BS in Human Services Management and a master’s in healthcare administration with a minor in Education. She is a member of the North Carolina Association Medical Staff Services and the National Association Medical Staff Services.