3-Part Credentialing Series: From Fundamentals to Advanced Strategies

3 Part Series Credentialing & Provider Enrollment: Basics to Advanced

Presenter: Yesenia Servin

Description:

Part 1: Credentialing Foundations: Navigating Medicare Enrollment for Providers

Title: Medicare Provider Enrollment 101: Complete Enrollment and Credentialing Process for Providers

Overview:

This session guides healthcare professionals through the complexities of Medicare provider enrollment, credentialing, and revalidation, explaining the CMS-855 forms and emphasizing the role of credentialing in the revenue cycle.

Learning Objectives:

Gain an overview of CMS connections necessary for compliant Medicare provider applications.

• Understand the distinctions between Part A facility applications and Part B organization and individual applications.
• Learn about reassignment applications and the revalidation process for various CMS-855 forms.
• Review each section of the application within the PECOS system.
• Familiarize with payer-specific rules and requirements for both government and commercial payers.

Topics Covered:

• Credentialing & Enrollment
• Joining the Network
• First Action Steps (I&A, NPI, NPPES, CAQH, Fee Schedules)
• Portals & Profiles
• Delegated vs. Non-Delegated Credentialing
• Building a Credentialing Database
• CMS & Availity Connections

Part 2: Credentialing in Practice: Document Management and Payer Applications

Title: Credentialing and Provider Enrollment 102

Overview:

A deeper dive into credentialing and provider enrollment. Includes document handling, payer communications, system setup, and customizable tools.

Topics Covered:

• Provider Documentation Requirements
• Verification and Validation
• Document Tracking
• System Maintenance (CAQH, PECOS, NPPES, I&A)
• Payer Applications (Medicare, Medicaid)
• Communication Strategies
• Post-Approval Steps
• Tools Provided: Printable/customizable forms and tracking tools

Learning Objectives:

• Understand the setup and maintenance of systems such as CAQH, PECOS, NPPES, and I&A.
• Learn full payer enrollment process.
• Gain knowledge of payer requirements and submissions.
• Develop skills to track applications effectively.

Part 3: Advanced Credentialing: Mastering NPPES, PECOS, and CMS I&A Accounts

Title: Credentialing and Provider Enrollment 103

Overview:

Advanced strategies for managing multiple systems and payer enrollments, with a focus on CMS platforms and surrogacy account management.

Topics Covered:

• CMS I&A System Setup
• NPPES Management
• Payer Enrollment Applications
• Application Tracking
• Surrogacy Program Utilization

Learning Objectives:

• Set up, maintain, and attest NPPES and I&A accounts.
• Complete payer applications accurately.
• Navigate payer-specific requirements.
• Track enrollment effectively.
• Manage multiple NPI profiles.