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

Do you know that credentialing and payer enrolment are the cogs that kick-start the revenue cycle of your organization? Payer/Provider Enrollment includes the payer-specific process to enroll your organization and provider with in-network participation. In-network participation equals in-network reimbursement for services rendered. Additionally, Provider enrolment has many moving parts that must be managed successfully because your organization’s bottom line depends on it. In provider enrolment, we must successfully and continuously maintain multiple provider profiles, directories, network portals, etc. You must update and revalidate information correctly. Any missed process in the cycle can negatively impact the provider’s network participation and the organization’s revenue cycle. This session will review the most common provider enrollment web portals and forms and how to manage them successfully. Expert Yesenia Servin, CPMSM, PESC will analyze provider enrolment, revalidation, and attestation and the impact they have on your organization’s revenue.

Enrolling with the Medicare program involves the various CMS-855 forms. There are now different forms that must be used by different providers of healthcare services or products. These forms are long, detailed, and sometimes confusing. Not only must they be filed initially for a given provider, they must be maintained and updated as appropriate. Due to the increasing complexity of healthcare delivery systems, providers, such as integrated delivery systems or large multi-specialty clinics, may have to maintain hundreds of these forms. Join expert Yesenia Servin, CPMSM, PESC, for this detailed review of the CMS 855 forms for Medicare participation. We will review both the paper applications and PECOS applications, Facility apps, Organization apps, and Individual apps. Failure to use the updated forms can cause outright rejection of the application and lead to significant delays in getting your providers enrolled.

Learning Objectives:-

Overview of CMS connection in order to remain compliant and to successfully complete Medicare provider applications
Understand part A Facility applications
Understand part B organization app and individual apps
Understand reassignment apps
To review the Medicare enrollment process through the use of the various CMS-855 forms
To address changes to the CMS-855 forms and/or changes in interpretations of the forms
To discuss the revalidation process for the various CMS-855 forms
Review each section of the application within PECOS
Know the payer-specific rules and requirements of both government and commercial payers.

Areas Covered in the Session:-

Health & Affirmations
Defined & Explained
Credentialing
Enrollment
Joining the Network
Pre-application
Network screening
Network invitation
Application/Agreement
Provider submission
current CAQH account
The network performs all phases of the process
Final determination; INN or denial
First Actions Steps
Name
TIN vs SSN
Identity & Access (I&A)
NPI
NPPES
Specialties
PECOS
CAQH
CPT List
Fee schedule
I&A Identity & Access Account
CAQH & NPI
Documentation
Discovery Phase: Why
Discovery Phase: Who
Discovery Phase: Where
Discovery Phase: When
Portals & Profiles
Payer Network Portals
Government Portals
Private Portals
Hospital Portals
Clearinghouse & Directory portals
Defined: Delegated & Non-Delegated
Build Your Own Credentialing Database
Build your own database; Excel, Access, OneNote, etc
Everything that is listed on your CAQH profile Maintain Employment History
New Opportunities
More Why’s?
Network information
Contract ID & Login
Communications details
Details of pre-app submission, full agreement submission Follow-up
Approval/Denial
Confirmation of Fee Schedule
I&A, NPPES login info
Completed training/internships
Expirable information
CMS Connection (Access Manager) to all EINs
Availity Connection
Access to payer platforms, i.e., UHC, Cigna.

Who will Benefit:-

Credentialing Specialist
Revenue Cycle Managers
Enrollment Specialist
Hospitals
Mental Health Providers
LCPC
LMFT
Practice, Clinic Owners
Hospital Leadership
Authorized Officials
Delegated Officials
Revenue Cycle Directors
Credentialing
Office Manager
Revenue Cycle
Operations
Billing Team
In and Out of Network Providers
Medical Billing Companies
Providers Office Staff
Physician
Hospitals and Facilities
Insurance Companies
Healthcare Attorneys
Executive and Administrators
Front Desk
Scheduling
Authorizations Staff
Medical Assistants
Certified Nursing Assistants