Description

Part 1 - Credentialing Foundations: Navigating Medicare Enrollment for Providers

11:00 AM EST - 12:00 PM EST

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. It explains CMS-855 forms and emphasizes credentialing's role 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

Who Should Attend:-

Credentialing Specialists, Revenue Cycle Managers, Enrollment Specialists, Hospital Administrators, Mental Health Professionals

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

12:05 PM EST - 01:05 PM EST

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

Who Should Attend:-

Practice Managers, Credentialing Specialists (PESC, CPMSM), Revenue Cycle Directors, CFOs, and related professionals.

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

01:10 PM EST - 02:10 PM EST

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.

Part 4 - Advanced Provider Enrollment, and Insurance Credentialing: Timelines, Tracking, and Payer Processes

02:15 PM EST - 03:15 PM EST

Title: Credentialing and Provider Enrollment 104

Overview:-

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

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

Background:-

Build on the credentialing and enrollment processes you have already learned and implemented.

Part 5 - Provider Enrollment 105

03:20 PM EST - 04:20 PM EST

• Importance of enrollment accuracy in complex healthcare organizations
• Government Payers & Compliance Requirements Multiple TINs and NPIs
• Multi-Specialty Organizations Enrolling and credentialing providers across different specialties
• Payer directory accuracy and specialty designation challenges
• Coordinating with credentialing, enrollment, and billing teams
• Case Studies & Scenarios
• Best Practices & Tools

Areas Covered in the Session:-

• NPI
• NPPES
• Medicare
• Medicaid
• Credentialing
• Enrollment
• Locums
• Enrollment Process
• Provider Rosters
• Timeline tracking
• Reporting
• Turn Around Time
• CAQH
• PECOS and Medicare enrollment pathways
• Medicaid variations by state
• Supervised providers (residents, fellows, advanced practice providers)
• Common pitfalls and audit risks

Learning Objectives:-

• Analyze and apply payer-specific requirements for government programs (Medicare/Medicaid) and supervised provider arrangements to ensure compliant and timely enrollments.
• Manage complex organizational structures by accurately enrolling and maintaining providers across multiple TINs, NPIs, and specialties.
• Develop strategies to prevent delays and revenue loss through proactive tracking, compliance monitoring, and coordination between credentialing, enrollment, and billing teams.

Build on the credentialing and enrollment processes you have already learned and implemented.

Who Will Benefit? 

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