Description

Not understanding where or how to get started with enrolling your organization’s providers is the first step and signal to get to know the tools widely used in the industry for Commercial and Governmental payers. Both PECOS and CAQH are the main tools for enrolling multiple types of providers into your Commercial plans and Medicare. Knowing how to set your organization up within each of the portals is fundamental to keeping your providers on target with enrollment and continuous monitoring.

This informative session will dive into each of the system tools to explain best practice setups and methods for easy usage and implementation.

Learning Objectives:

• Identify the widely used tools within the Payer Enrollment and Commercial Payer industry (CAQH, PECOS)
• Learn the purpose and functions of CAQH in the payer enrollment industry
• Understand the Medicare ecosphere for Provider Enrollment
• Understand the functions of the Identify & Access system
• Understand the functions of the NPPES system and its importance to Credentialing & Payer Enrollment
• Understand the Medicare ecosphere for Provider Enrollment
• Learn the differences between the three systems and how each of them interacts with each other
• Explain some of the best practice workflows to implement from a paper to electronic process using PECOS and CAQH

Areas Covered in the Session:

• I&A, PECOS and NPPES relationships – Setting up your organization
• Medical Staff Role
  • Setting up Provider record or the Organizational record
  • Ensuring continued compliance with Medicare Program
    • Initial Enrollment
    • Revalidation
    • Changes of Information (CHOI & CHOW)
• POCOS, I&A & NPPES Relationship
• Access Levels (Authorized, Designated and Surrogacy)
• Enrollment – Process for Providers & Groups
• CHOIs and CHOWs – Compliance Fundamentals and Best Practices
• Telemedicine Fundamentals for Enrollment (Distant/Originating Sites)
• Access Roles for Enrollments
• What is needed for enrollment?
  • Sole Proprietors, Individual Physician & Non-Physicians
  • Provider or Supplier Organizations
  • Requesting Access
• Linked to PECOS Records
• Enrollments
• Starting Application
• PAR Status Information & Special Payments address
• Reassignment Information
• Organizational Control
• Individual Control
• Submission of Application
• Revalidation
• Telemedicine
• CAQH
• What are the benefits of CAQH
• Who uses CAQH?
• Getting Started with CAQH
• Maintaining Provider Profiles
• Information needed to complete application
• Documents needed to complete application
• Intake Process
• Documentation
• Organizing CAQH for your Organization
• Organizational Module (Practice Manager)

Attendees:

• Payer Enrollment Specialists
• Credentialing Specialists & Coordinators
• Medical Staff Leadership
• Revenue Cycle Leadership
• Managed Care Enrollment Coordinators & Specialists
• CPCS, CPMSM Certified individuals
• Credentialing and Enrollment Specialists, Experts & Leaders
• Healthcare Administrative Teams
• Practice Managers
• Healthcare Billing Specialist
• Staff Providing NPI Support, NPPES  Support
• Staff Providing CAQH Support
• Clinic Managers
• Allied Health Providers
• Advance Health Practitioner
• Enrollment
• Office Managers
• Operations
• Coders
• Clinical Directors
• Practice Owners
• Claims Teams
• MSPs