This comprehensive webinar, led by expert Cati Harris, CBCS, is tailored for individuals new to credentialing, those involved in building a credentialing program, or anyone looking to refresh their credentialing skill set. The course covers essential topics in provider enrollment, offering valuable insights and practical guidance. Participants will gain knowledge on provider credential verification, the setup and maintenance of crucial systems such as CAQH, NPPES, PECOS, and I&A, CV verification, application preparation, review and submission processes, identification of red flags, linking providers to existing contracts, re-verification procedures, and ongoing provider file maintenance. The webinar also includes a FAQ section and guidance on establishing a successful provider enrollment program. As a bonus, attendees will receive multiple free printable and customizable forms for provider enrollment. The webinar concludes with a live Q&A session, providing participants with the opportunity to have their specific questions addressed. Whether you are new to credentialing or seeking to enhance your existing knowledge, this webinar offers a detailed view of provider enrollment, maintenance, and the development of successful programs. Register, https://conferencepanel.com/conference/a-guide-to-provider-enrollment-and-building-a-successful-provider-enrollment-program

1. A Guide to Provider Enrollment
Building a Successful Provider Enrollment Program
A Webinar Presented By
Cati Harris, CBCS, CCS, 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
14 private practices(35+physicians/PA/NP)
Educational Experience:
● Diploma withHonors inMedical Billing&Coding
● Certified Billing and Coding Specialist
● Certified Provider Credentialing Specialist
● Certified Credentialing Specialist

3. Learning Objectives
Welcome to the Webinar!
This webinar was developed to provide you with information on building
your credentialing program with focus on the preparation, verification,
submission, and completion of the provider credentialing process.
● When to Start Credentialing
● 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
● Items to complete once the provider is credentialed/contracted
● Linking of a previously credentialed provider with payers to your tax id/contracts
● Brief overview of Provider Revalidations

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

5. RESEARCH
Research is the key to SUCCESSFUL Provider Credentialing
The research process is divided into two parts:
● Provider Research
● Payer Research

6. First Step -Provider Research Questions
● What is the providers anticipated start date?
● Is the provider newly licensed?
● State Approved Medical License
● Does the provider have a registered NPI?
● Has the provider been previously credentialed with payers?
● 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?

8. Research -Payer
● Payer Application and Document Requirements
○ Copy of Application and Applicable Forms
○ Online Payer Application Location
○ Payer Estimated Processing Time
○ Payer Preferred Submission Method
● Payer Contact Information
○ Website, Email, Phone, Fax
● Payer Provider Representative Contact Information

10. 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
○ Verify Provider Education, Residency, Fellowship etc.
● 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 (I/A, PECOS -Prefer Surrogate Access)
○ Attest CAQH every 60 days (120 days is requirement)

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. ● 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

13. ● 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
■ Prefer Access via Surrogate
○ 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

14. Application Preparation
Completion of the payer application with current and accurate information is critical to the
provider enrollment process.
Errors on the application or within the application package can result in holds or
rejections
● Complete all fields on application. Do not leave any blanks.
○ If the information does not apply enter N/A in the space.
○ Do not write to refer to another document in the space.
● Review document a min of 2 times
○ Once doing a forward review
○ Once doing a reverse review

15. Linking a Provider already PAR with the PAYER
If the Provider is already credentialed/contracted with the payer as a participating
(PAR) provider, you will need to complete a link to your TAX ID and group contract.
To Complete a link:
● Complete the Provider Link Letter
○ Include the Tax ID, Group NPI, Practice Address, Phone, Fax
○ Include the provider/mid-levels Name, Individual NPI
○ Include the effective date of the link
○ Include a current W9 for the group
● Once you have completed the above information, you will submit the link letter via the preferred
method for the payer. Most payers have a specific email or fax they want the request submitted to.
Make a call to the payer to ensure the specific method of transmission of the link letter.
● Exception: Medicare/Medicaid -For Medicare you will complete the reassignment of benefits in
PECOS by submitting a change of information application under the current enrollment. Medicaid
varies by state, contact your local Medicaid enrollment office for directions

16. Provider Re-Validation
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. Termination of a Provider
In the course of business, there may come a time in which a provider is terminated
from your practice, whether it be voluntary or involuntary. When this takes place,
there are steps you need to complete as the group to ensure the provider is no
longer linked to your tax id and group contract with the payer.
● Prepare the Letter Requesting a Provider Termination.
○ Include the Tax ID, Group NPI, Practice Address, Phone, Fax
○ Include the provider/mid-levels Name, Individual NPI
○ Include the effective date of the termination
○ Include specific language that requests the provider be removed from your group contract and
unlinked from your Tax ID with the payer.
● After you submit the letter, follow up within 72 hours of submission to ensure receipt and processing
of the termination.
● Exception: Medicare/Medicaid -This will be done in the provider’s PECOS by removing the
reassignment of benefits to your practice and updating the contact information. This can be done by
the provider. Request proof of completion and approval from the provider. For Medicaid, contact
Medicaid for yoru state directly and follow the process.

18. Tracking
Provider Enrollment Tracking is the foremost action to
ensure timely, efficient submission and processing of
the provider enrollment 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

19. Provider Document Tracking
.
DOCUMENT TRACKING TOOLS:
● Provider Document Checklist
● Excel Tracking Spreadsheet

20. Communication
Communication is the key to successful and
timely processing of your providers
credentialingapplication.
Keystosuccessfulcommunication:
● Consistent updatesprovidedto the
providerandappropriate
administrative staff vialive google doc
linksand/orEmails
● Consistent trackingandfollow upon the
statusofthesubmittedpayer
applications.
● Trackingthepayerprovided
estimated processing times.
● Updating/MaintainingTracking Tools

21. Stepsto 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 - Research billing Incident Too

22. Provider CredentialingisApproved…..
What isnext?
● 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

23. Once you have the requested payer approval information,
you will need to store a physical and digital copy.
● Create a Provider Binder
○ Section for each Provider
■ Within Each Provider Sections, Organize by Payer
● Payer Section includes:
○ Provider Information Sheet
○ Payer Welcome/Approval Letter
○ Effective Date, Revalidation Date
○ Payer Specific Provider #
○ Copy of Contract/Fee Schedule
○ Original Submission Package
Information Storage

24. Included with this webinar are several forms mentioned throughout the presentation
● Credentialing Description of Services
● Provider Enrollment Information, CV Requirements, Document Checklist
● CAQH Attestation Form
● Cover Letter, Fax Cover Letter for Payer Application Submissions
● Cover Letter, Fax Cover Letter, and Provider Link Letter
● Verification of Licensure/Certification/Education Form
● Tracking Spreadsheet
● Payer Application Information Form
● Termination Letter
If you did not receive the forms with this presentation, please reach out to me via
email: cballard@mysolor.com
Forms

25. Are you in need of an experienced
credentialing professional?
If you answered “YES”, please contact
me to arrange your FREE consultation
for credentialing services.
Mention Code: WEBINAR to Receive a discount on
contracted services!
Cati Harris, CBCS,
Director of Provider Credentialing
Solor, Inc
Phone 704-675-7279
Email: cballard@mysolor.com

26. 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