Successful Payer Credentialing & Enrollment for Multi-Location Practice

This intermediate presentation will provide training and guidance on creating a successful payer credentialing & enrollment process. The presenter will go over crucial steps including credentialing, provider enrollment, billing, and revenue cycle management. Providers will understand how to create an efficient credentialing/enrollment process. Review how these processes impact claims submissions and receive claims reimbursement from different payers. During this workshop, providers will understand CAQH, NPPES, I&A, Availity, ERA and EFTs, and the Medicare portal.

Licensing and credentialing telehealth providers can pose challenges to expanding telehealth programs in rural communities. Licensing and credentialing are intended to protect patients by ensuring that telehealth providers are in compliance with state regulations and hospital policies. With COVID-19, there are many struggling hospitals, physician deficiencies, and insufficient access to healthcare providers. Many healthcare facilities invest more time, money, and resources into upgrading their telehealth offerings to neutralize these shortages.

Areas Covered in the Session:

1. Organizations with Payer “Delegated Agreements” (Typically there is a provider limit of 300 & up, based on payer)
   • Credentialing Process
   • Enrollment Process
     1. Multiple Locations
     2. Multiple NPIs
     3. Multiple Tax IDs
     4. Government Payers
     5. Commercial Payers
   • Provider Account Management
     1. CAQH
     2. I&A, NPPES
     3. PECOS
2. Organizations that do not hold Payer “Delegated Agreements”
   • Credentialing Process
   • Enrollment Process
     1. Multiple Locations
     2. Multiple NPIs
     3. Multiple Tax IDs
     4. Government Payers
     5. Commercial Payers
   • Provider Account Management
     1. CAQH
     2. I&A, NPPES
     3. PECOS
3. Additional credentialing & enrollment process to review
   • Multiple Locations
   • Multiple NPIs
   • Multiple Tax IDs