Are you wanting to update your credentialing skill set? Do you have providers you are responsible for maintaining their CAQH and credentialing with all payers? Is it time for your provider's revalidation? If you answered yes, then you have found the webinar made just for you! Join expert Cati Harris, CBCS as she presents this detailed, comprehensive webinar providing you with the steps to maintain your provider's CAQH, PECOS, payer enrollments, and completing provider revalidations. This webinar features a guide to provider credentialing, maintenance of provider enrollments, and completing provider revalidations. Also includes multiple printable and customizable forms for payer/application cover letters, provider documentation requirements, Verification of Documentation, CV requirements, application submission, payer linkage, provider revalidation, employment history, and much more! At the end of this information-packed webinar, you will have the opportunity for a live question/answer session. Register, https://conferencepanel.com/conference/provider-credentialing-maintaining-provider-enrollments-updates

1. Provider Credentialing
Maintaining Provider Enrollments, Updates, and Re-Validations
A Webinar Presented by: Cati Harris, CBCS, CPCS
Director of Provider Credentialing -Solor, Inc

2. Cati Harris, CBCS, CPCS
Director of Provider Credentialing & Contracting
Solor, Inc.
Professional Experience:
● Over 20 years experience in Medical Billing, Coding, Provider
Credentialing/Contracting
● 15 years clinical experience
● Currently provide credentialing services for 2 major hospital systems,
and 15 private practices (40 + physicians/PA/NP)
Educational Experience:
● Diploma with Honors in Medical Billing & Coding
● Certified Billing and Coding Specialist
● Certified Provider Credentialing Specialist

3. Learning Objectives
Welcome to the Webinar! Provider Credentialing: Maintaining Provider Enrollments, Updates,
and Re-Validations. This webinar covers the credentialing process including provider
enrollment maintenance, CAQH/PECOS Maintenance, and revalidations. t
● When to start credentialing
● What is needed to maintain provider enrollment with payers?
● Setup and Maintenance of NPPES, I&A Management System, CAQH, PECOS
● How to review, validate, and track provider documents
● How to Prepare, Review, Submit, and Track Payer applications
● Linking of a previously credentialed provider with payers to your tax id/contracts
● Re-Validations
● Credentialing Tips

4. Credentialing
Keys to Success
● Research
● Preparation
● Tracking
● Communication

5. Provider Research
Provider Research includes questions to ensure you have the vital information
to proceed with the Provider’s credentialing.
● Does the provider have a registered NPI?
● Is the provider newly licensed?
● What is the providers anticipated start date?
● State Approved M edical License
● Does the provider have any disciplinary actions, previous
criminal charges, or malpractice claims?
● Mid-Level - Is the supervising md approved?
● Mid-Level - Is the collaborative agreement signed?
● Has the provider been previously credentialed with payers?

6. Research -Provider
● Provider Welcome Packet
○ Welcome Letter
■ Include a brief introduction of yourself
■ Provide Contact Information and Office Hours
○ Description of Services
■ Provide Description of the services you will be providing for the provider
● Maintenance of CAQH, NPPES, I/A System
■ Include your fee for credentialing services
● Include payment information and payment terms
○ Clearly Define the Expectations of the Provider/Provider Support Staff for return of
documents and communication.
■ Provide timelines of document return expectations

7. Provider
Welcome Package
Documents
Provider Enrollment
Information Document
Tip
Please email
cballard@mysolor.com
for a copy of the
documents referenced
in this webinar
Provider Document
Checklist
Provider CV Requirements
Welcome Letter
Description of Services

8. Payer
Documents
Payer/State Applications
Payer Contact Information
Tracking Spreadsheet

9. Provider Document Preparation
● Review All Documents for Accuracy, Dates, Infractions
○ Verify Licensure and Board Certifications are current with no infractions -Explain previous
disciplinary actions
○ Verify Malpractice Insurance is for current group and review for previous claims
■ Previous Malpractice Claims -Provider must provide detailed information/explanation
○ Verify DEA License is Current without restriction
● Create a Provider File
○ This file will contain all original documents.
■ It is suggested to save a copy of the originals in a secure location on your computer.
■ Organization of the Provider File (Two Sided Folder)
● Access Provider Logins
○ CAQH, PECOS, I&A, NPPES
○ Attest CAQH every 60 days (120 days is requirement)

10. When credentialing a provider, you will need to access various
management systems to ensure the information is accurate, current, and
attested. The managements systems to access:
● NPPES
● Identity & Access Management System
● CAQH
● PECOS
NPPES, CAQH, Identity & Access Management, PECOS

11. ● NPPES -https://nppes.cms.hhs.gov/#/
○ Obtain Login/PW or Setup access (The login for the I&A System is the same for NPPES)
○ Verify Provider Information
■ Correspondence Address and Practice Address
■ Provider Contact Information
■ Phone number, Email
■ Taxonomy
■ Delegated Access
■ Provider ID#’s
● NPPES Must be current and approved before proceeding with any provider
credentialing.
● Print out any update confirmations completed
NPPES

12. Now we will see an example of the NPPES system and
each section.
This information will show from the start to finish in
NPPES
NPPES

13. ● CAQH -https://proview.caqh.org/Login/Index?ReturnUrl=%2f
○ Obtain Login/PW or Setup access
○ Review/Complete each section
○ Add your information in the credentialing contact
○ Add your email on the provider info page as a secondary contact
○ Ensure the Authorization Section is Checked to Allow all Payer Access
○ Upload the following documents
■ Attestation
■ Certificate of Insurance
■ State License
■ DEA
■ Provider CV
■ Board Certification
■ Med School Degree including any Residency or Fellowship Cert
CAQH

14. ● PECOS -https://pecos.cms.hhs.gov/pecos/login.do#headingLv1
○ The login for PECOS is the same username and password used for I&A Management System
○ Select My Associates
■ Scroll to bottom and check for current enrollments
● If provider is currently enrolled, check to see if the provider is enrolled with the correct
state and MAC.
■ If provider is not enrolled, you will select to start the process.
● Complete all tabs, run an error check, locate name of group authorized signatory for
the reassignment of benefits
● Once error check shows no errors, you can complete submission
○ Be sure to print out copy of application and submission
○ You will receive email confirmation
■ Re-Validations
● Select revalidation notification center instead of “My Associates”
PECOS

15. Payer Document
Preparation
● Review Payer Application Requirements
● Complete Payer Application
● Organize/Review Application Package
with Required Documents
● Prep Application Package Cover Letter
● Check current payer processing times
● Submit Complete Application Package
to Payer

16. Provider Revalidation
All Payers require re-credentialing/re-validation once the provider is credentialed.
Important Information Regarding Provider Re-Validations/Re-Credentialing:
● When the provider is initially credentialed, inquire with payer when the re-credentialing will
be due.
○ Most payers are either every 3 years or Every 5 years
● Maintain a database or spreadsheet for each provider with the payers re-validation dates
listed.
● At least 60 days prior to re-validation due date, inquire with the payer the requirements for
the providers re-validation
● Ensure CAQH is up to date and attested prior to inquiring or beginning re-validations.
● PECOS aka Medicare Re-validations are every 5 years
○ Select revalidation notification center instead of “My Associates” within PECOS to
obtain due date of re-validation and to complete the process.

17. Tracking
Tracking is the single action that can ensure timely,
efficient submission and processing of the providers
payer application package.
Lack of tracking can lead to:
● Payer misplacing application package
● Delayed application submission and processing
● Missed request for more information, missing
documentation
● Application being Red Flagged by Payer
● Financial loss and increased credentialing costs

18. Tracking is Divided Into Two Parts:
● Document Tracking
● Application Tracking

19. Communication
Communication is the key to successful
and timely processing of your providers
credentialing application.
Keys to successful communication:
● Consistent updates provided to the
provider and appropriate
administrative staff via live google
doc links and/or Emails
● Consistent tracking and follow up on
the status of the submitted payer
applications.
● Tracking the payer provided
estimated processing times.
● Updating/Maintaining Tracking Tools

20. Steps to Minimize Financial Impact
● Begin the credentialing process a minimum of 60 days before provider
anticipated start date. Preferably 90 days.
● Maintain CAQH and attest every 120 days
● Ensure I&A, NPPES login stay up to date with accurate information.
● Consistently follow up with payers to ensure timely processing.
● Organize and maintain all provider data, documents, and applications. Update
frequently.
● Timely Provider and administrative staff credentialing status updates.
● Maintain Live Update Document (Google Sheet, One Drive, MS Teams,Etc)
● Maintain tracking spreadsheet for provider payer applications submissions
and updates.
● For Mid-Levels only,Bill as Incident Too

21. Once the Provider Credentialing is Approved…..
What is next?
● Request copy of approval/welcome letter from payer
● Request payer specific provider #
● Inquire when the revalidation will be due
● Request copy of contract and fee schedule
○ Review both the contract and fee schedule prior to signing
○ Once signed, request copy of signed contract
● Create Master Information Sheet with payer specific information
○ Credentialing effective date
○ Payer Specific Provider #
○ Contract Effective Date
○ Fee Schedule Effective Date

22. Cati Harris, CBCS,
Director of Provider Credentialing
Solor, Inc
Phone 704-675-7279
Email: cballard@mysolor.com
Thank you for your time and
attendance!
Questions?
Register Now