Credentialing and Provider Enrollment - 102, 103 and 104. Mega 3 Part Webinar Series. A Detailed Guide to Provider Enrollment 2025

Description

Credentialing and Provider Enrollment - 102, 103 & 104.
Mega 3 Part Webinar Series.
A Detailed Guide to Provider Enrollment 2025

Title 1 - Credentialing and Provider Enrollment - 102

This is the second session of our Credentialing and Enrollment series. Yesenia presents this detailed, comprehensive webinar to help you successfully credential your providers and mid-level providers. The session features a complete step-by-step guide to provider credentialing, including customizable forms for payer/application cover letters, provider documentation requirements, verification of documentation, CV requirements, application submission, payer linkage, provider revalidation, employment history, and much more. You will also receive tracking tools to support the tracking/verification of provider documents and payer application tracking.

• Provider Documentation Requirements
• Verification/Validation of Provider Documents
• Provider Document Tracking
• Setup/Maintenance of Provider File
• Setup/Maintenance of CAQH, PECOS, NPPES, I&A
• Provider Portals & Profiles
• Payer Application Requirements
• Payer Application Prep/Submission
• Payer-Specific Enrollment Information
• Payer Application Tracking
• Medicare/Medicaid Enrollment
• Provider Linkage to Payer
• Efficient and Timely Communication
• Steps to Complete Once the Provider Is Approved by the Payer
• Multiple Printable/Customizable Forms, Letters, Tracking Tools

Title 2 – Credentialing and Provider Enrollment - 103

The NPPES interface is complex and confusing. Your organization’s and providers’ CMS National Plan and Provider Enumeration System (NPPES) account is about much more than just acquiring a National Provider Identifier (NPI), and maintaining it accurately and compliantly can be frustrating. Whether you manage one account or fifty, you can improve results with expert guidance from nationally certified credentialing specialist Yesenia Servin, CPMSM, PESC.

• Review that taxonomy details are accurate.
• What if your application gets denied or rejected?
• What if your claims are being labeled as out-of-network, but you have an in-network approval?

Learning Objectives

• Setup/Maintenance/Attestation of NPPES, I&A
• How to complete payer enrollment applications
• Follow-up process for provider enrollment applications
• Payer-specific requirements for applications and submission
• Payer-specific contact and submission information
• Tracking of payer enrollment application packages
• Create a strong I&A to securely access CMS systems such as NPPES & PECOS
• Utilize the surrogacy program to manage multiple NPPES accounts within your own account
• Accurately and efficiently complete an NPPES registration on the first try
• Manage multiple NPI profiles within your account
• Understand specialities and taxonomies

Title 3 – Credentialing and Provider Enrollment - 104

In this session, we explore the advanced components of the provider enrollment process with a focus on operational efficiency and compliance. Key topics include tracking enrollment timelines, navigating healthcare plans and product structures, and managing provider data through reporting and rostering tools. We also delve into government payer processes and requirements, highlighting distinctions between commercial and public programs.

Attendees will gain practical insights into streamlining enrollment workflows, ensuring data accuracy, and maintaining alignment with regulatory standards across payers.

Learning Objectives

• Identify key timelines, payer requirements, and documentation needed to successfully complete provider enrollment across commercial and government health plans.
• Demonstrate an understanding of effective tracking, reporting, and rostering practices to ensure compliance and data accuracy throughout the provider enrollment process.

Areas Covered in the Series

• NPI
• NPPES
• Medicare
• Medicaid
• Credentialing
• Enrollment
• Locums
• Enrollment Process
• Provider Rosters
• Timeline Tracking
• Reporting
• Turnaround Time
• CAQH

Who Should Attend

• Practice Managers
• PESC
• CPMSM
• Revenue Cycle
• Directors
• CFO
• Credentialing
• Provider Enrollment
• EFT Enrollment
• Operations