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.
