Credentialing 101: A Detailed Guide to Provider Credentialing

Credentialing 101: A Detailed Guide to Provider Credentialing

Credentialing 101: A Detailed Guide to Provider Credentialing is a foundational training session designed for professionals entering the world of healthcare provider credentialing. Whether you’re onboarding your very first provider or expanding your services across multiple states and specialties, this webinar will equip you with a comprehensive understanding of the credentialing lifecycle.

Participants will gain in-depth knowledge on how to prepare and submit credentialing applications, understand payer requirements, and navigate the varying processes based on provider types including mental health professionals, optometrists, allied health professionals, medical doctors, facilities, and ancillary services.

We’ll break down the essentials of insurance panelling, such as how to set up and maintain CAQH profiles, utilize NPPES for NPI data, register and navigate PECOS, and manage key portals like Availity. You’ll learn how to interpret insurance terminology, track credentialing progress, and work effectively with insurance representatives—distinguishing between national carriers, local HMOs, and union plans.

This course emphasizes strategic planning, communication with clients, compliance best practices, and smart use of software tools to ensure credentialing stays organized, timely, and successful. We’ll also explore how credentialing professionals can think outside the box, identify IPA opportunities, and stay current with evolving insurance guidelines.

• Understand the complete provider credentialing process and its phases
• Identify and explain key terms, systems, and documents involved (e.g., NPI, CAQH, PECOS, Availity, W-9, malpractice insurance)
• Recognize how credentialing requirements vary by provider type (e.g., behavioural health vs. vision vs. facility-based care)
• Navigate multistate credentialing and licensing considerations
• Distinguish between insurance types (local HMO, national plans, and unions) and understand who the reps are
• Establish and maintain strong communication with clients and payer reps to manage expectations and streamline credentialing timelines
• Build a credentialing plan of action with due dates and progress tracking methods
• Leverage technology and software tools to organize, automate, and monitor credentialing workflows
• Stay current with insurance news and updates to reduce denials and anticipate changes
• Learn what to avoid during credentialing and common pitfalls that delay approvals

• Agenda
• What is Credentialing & Why It Matters
• Key Systems & Documents
• • NPI
  • CAQH ProView
  • PECOS
  • Availity & Payer Portals
  • Supporting Documents
• The Credentialing Process (Phases)
• Laying the Groundwork for Success
• Specialty-Based Variations
• • Physicians (MD/DO)
  • Therapists
  • Optometrists
  • Facilities
  • DME Providers
• Multistate Credentialing & Medicaid
• Insurance Types
• Maintaining Communication
• • With Providers & Their Team
  • With Payers
• Efficiently Communicating Progress
• What Data to Track?
• Tracking Checklist
• Common Mistakes to Avoid
• Escalating Issues with Payers
• Timeline Realities, Denials & Re-Credentialing
• • Timeline Realities vs. Best Case
  • Denials & Appeals
  • Credentialing / Maintenance
• Tools & Technology
• Staying Current & Thinking Strategically
• Strategic Planning & IPA Opportunities
• Live Q&A Session

• Credentialing and Enrollment Specialists
• Credentialing and Enrollment Experts
• Credentialing and Enrollment Leaders
• Healthcare Administrative Teams, Personnel
• Practice Managers and Administrator
• 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