Successfully Manage the Plethora of Provider Profiles: CAQH, NPPES, PECOS, Availity, Navinet, Directories

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In Provider Enrollment, we must successfully and continuously maintain multiple provider profiles, including CAQH, I&A, NPPES, PECOS, Directories, Network portals, etc. A credentialing professional that is part of the payer enrollment process is updating and/or revalidating information. Any missing piece in the cycle can negatively impact the provider’s network participation and the organization’s revenue cycle. This session will review several of the most common provider enrollment web portals and how to manage them successfully.

Learning Objective

• Review the various portal processes involved in provider enrollment
• Identify tips and tools that will assist you in managing the portals
• Define the purpose of each portal and discuss the requirements
• Discuss which profiles are a must
• Maintaining multiple provider profiles effectively

Areas Covered in the Session

• Identity & Access Management System
  • I&A – Organizations
  • I&A – Providers/Practitioners
  • I&A – Enrollment Specialists
• National Plan & Provider Enumeration System (NPPES)
  • NPPES – Organizations
  • NPPES – Providers/Practitioners
  • NPPES – Enrollment Specialists
• Provider, Enrollment, Chain & Ownership System (PECOS)
  • PECOS – Organizations
  • PECOS – Providers/Practitioners
  • PECOS – Enrollment Specialists
• CAQH (Council for Affordable Quality Healthcare) ProView
  • CAQH ProView –  Provider
  • CAQH ProView – Practice Manager
  • CAQH ProView – Participating Organizations
• Additional Provider Profiles and Directories
  • Availity
  • Navinet
  • LexisNexis
  • BetterDoctor

Suggested Attendees

• Practice Managers
• Healthcare Billing Specialist
• Staff providing NPI support, NPPES support
• PESC, CPMSM, CPCS
• Staff providing CAQH support
• Clinic Managers
• Allied Health Providers
• Advance Health Practitioner
• Credentialing
• Enrollment
• Office Managers
• Operations
• Revenue Cycle
• Coders
• Clinical Directors
• Practice Owners
• Claims Teams
• MSPs

About the Presenter

Yesenia Servin is an expert in credentialing and provider/payer enrollment with 22 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
• Analyzes revenue cycle management
• Guides the credentialing and payer enrollment structure

Yesenia is the payer enrollment lead with TeamMed Global. She manages payer enrollment, keeps team members up to date on industry trends, and is a liaison to all departments that impact payer-enrollment processes. In previous positions, Yesenia has worked 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 Team Med Global Lead Collaborator, Team Med Global University Faculty, NAMSS member, and is a current and past NAMSS Educational Conference Guest Speaker, a current member of the NAHRI Leadership Council, current trainer for The Chicago School of Professional Psychology and industry trainer. Yesenia studied microeconomics and communications at NEIU and is currently studying healthcare administration at Concordia University Chicago.

Yesenia enjoys spending time with her family and pugs. She finds great joy in jumping in the mini-van for a family road trip.