A Guide To Provider Credentialing: Preparation And Tracking

About Course

Conference Material (Password Required)

When onboarding a new provider to your practice, the slightest errors can result in significant reimbursement delays and rejection of your provider credentialing application package. To fully credential and contract the provider with payers, you must complete specific requirements, documents, and payer-specific requirements. Failure to do so can impact your provider/practice revenue and greatly affect patient care. Even simple errors can cause payers to delay or reject your application package. This can lead to you having to start over with the entire credentialing process. Your new provider must start seeing patients as soon as possible to lessen the financial impact.

During this webinar, Expert Cati Harris, CBCS, walks you through each step of the credentialing process for providers. You will learn documentation requirements, application requirements, payer-specific requirements, document, and application package prep, credentialing package submission, setup, and maintenance of CAQH, PECOS, and tracking of applications submitted to payers, and final steps once approval has been received. This will also include a review of provider revalidations. You will also learn how you can make your onboarding process more efficient and accurate to speed up your billing process and get paid more quickly.

Learning Objective:

  • When is it possible to start credentialing a new physician?
  • What is the process for Setup/Maintenance/Attestation of CAQH, PECOS
  • 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/activity.
  • 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.
  • The 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

  • Payer-specific enrollment information
  • Payer application submission
  • Application tracking
  • Medicare/Medicaid Enrollment
  • Provider Documentation Requirements
  • CAQH and PECOS
  • Verification of provider documents and licensure
  • Payer application requirements
  • State Requirements
  • Efficient and Timely Communication
  • Contract and Fee Schedule Review
  • Steps to complete once the provider is approved by the payer.
  • Sample forms provided

Suggested Attendees

  • Credentialing and Enrollment Specialists
  • Credentialing and Enrollment Experts
  • Credentialing and Enrollment Leaders
  • Credentialing
  • Enrollment
  • Office Managers
  • Operations
  • Revenue Cycle
  • Coders
  • Clinical Directors
  • Practice Owners
  • Claims Teams
  • Healthcare Administrative Teams, Personnel
  • Practice Managers
  • Healthcare Billing Specialist
  • Staff Providing NPI Support, NPPES Support
  • Staff Providing CAQH Support
  • Clinic Managers
  • Allied Health Providers
  • Advance Health Practitioner
  • 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 and contract/fee schedule negotiations for providers with all major payers.

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
  • Course Key
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