Looking to master the provider credentialing process?

Join expert Cati Harris, CBCS, in this comprehensive webinar designed to guide you through each step of successful provider and mid-level credentialing. This session will cover a detailed, step-by-step approach, complete with over 10 customizable forms for payer cover letters, documentation verification, CV requirements, and provider revalidation, plus tracking tools for document verification and payer applications.

The focus of the 2025 updates to the Credentialing Product Suite ensure that organizations can maintain a high-quality network for members and clients, while providing a framework for adopting industry best practices to promote accurate and efficient verification of practitioner credentials – ensuring that medical organizations employ qualified professional and align with state requirements.

You’ll also learn to set up and maintain essential credentialing databases like CAQH, PECOS, and NPPES, along with best practices for document verification and payer application submission. By the end, you’ll have an organized framework for credentialing, along with practical tools to streamline your process. The session concludes with a live Q&A, offering a chance to address your specific questions on effective credentialing practices.

Learning Objectives:

• Eligibility and Timing: Know when to start the credentialing process for providers and mid-level practitioners.
• Key Requirements: Discover essential documents needed to begin credentialing for healthcare providers.
• Document Verification: Learn how to validate and verify provider documents for accuracy and compliance.
• Tracking Systems: Implement tools to efficiently track provider documentation throughout the credentialing process.
• Organizing Provider Files: Establish and maintain comprehensive provider files to ensure data accuracy.
• Payer Enrollment Details: Understand payer-specific requirements, including enrollment protocols and documentation.
• Credentialing Databases: Set up and maintain CAQH, PECOS, NPPES, and Identity & Access (I&A) for streamlined credentialing.
• Application Preparation and Submission: Master the submission process for provider enrollment applications across different payers.
• Payer-Specific Submission Protocols: Access payer-specific contact information and application submission guidelines.
• Application Tracking and Communication: Track application progress and manage communication updates for a seamless credentialing process.
• Post-Approval Steps: Complete the final steps needed once credentialing has been approved by the payer.

Key Changes Include:

• Consolidated Credentialing Program: NCQA is streamlining credentialing by combining its Credentialing Accreditation and Credentials Verification Organization (CVO) Certification. This Single Credentialing program aims to simplify the accreditation process and provide more certification options, helping organizations maintain high-quality networks more efficiently.
• Shorter Verification Timeframes: Organizations will need to verify provider credentials within a reduced timeframe, leveraging technology to ensure more current data access. This is critical for risk mitigation and enhances patient protection, shortening enrollment periods for providers in healthcare networks.
• Ongoing Monitoring and New Audit Requirements: Updated standards mandate monthly monitoring of provider credentials, including license expirations. Additionally, a new Interim Survey option is introduced, allowing organizations to undergo a streamlined review before pursuing full accreditation within 18 months.
• Focus on Information Integrity: Credentialing systems must now include controls to prevent inappropriate documentation or fraudulent alterations. New audit protocols will review data integrity and require training for staff on information integrity principles.

Who Should Attend:

• Credentialing and Enrollment Specialists
• Credentialing and Enrollment Support Staff
• Credentialing and Enrollment Experts
• Credentialing and Enrollment Leaders
• Healthcare Administrative Teams, Personnel
• Practice Managers
• Healthcare Billing Specialist
• Staff Providing NPI Support, NPPES Support
• PESC, CPMSM, CPCS
• Staff Providing CAQH Support
• Staff Providing PECOS Support
• Clinic Managers
• Allied Health Providers
• Advance Health Practitioner
• Providers (MD, DO, NP, PA)
• Credentialing
• Enrollment
• Office Managers