PERFECTING YOUR CREDENTIALING PROCESS TO IMPROVE YOUR FINANCIAL HEALTH. Brittany L. Rongey, MHA

Transcription

1 PERFECTING YOUR CREDENTIALING PROCESS TO IMPROVE YOUR FINANCIAL HEALTH Brittany L. Rongey, MHA

2 OBJECTIVES What is credentialing anyway? Check this checklists that work Documentation Technology needed? Get ready, set, go! Sign this Follow-up what? Tricks & tips

3 WHAT IS CREDENTIALING ANYWAY? Why is it important?

4 WHAT IS CREDENTIALING ANYWAY? Common Pain Points Timing Missing documents/unresponsiveness Revalidation requests Access to information Knowledge of payer process Lack of time In ability to track productivity Provider set-up incorrectly Lack of follow-up HOW MUCH IS IT COSTING YOU?

5 WHY DOES IT MATTER? Out of Network Patient dissatisfaction Denied Additional staff time

6 Can we fix it? Yes we can!

7 COMMUNICATION IS KEY HR Onboarding Provider Enrollment Provider or liaison

8 WHAT IS YOUR PROCESS? Pre-employment meeting Practice Startup Contract meeting Provider Enrollment HR/Onboarding

9 WHERE CAN THEY FIND IT? DOES EVERYONE KNOW IT?

10 CHECK THIS! CHECKLISTS THAT WORK

11 DOCUMENTATION Instructions Explain importance Enrollment means payment Timeline Cell number We will text you Additional contact No option immediate attention

12 DOCUMENTATION New Provider Request DEA certificate Medical license Issue date versus expiration date Board certifications Diploma(s) References Name, phone number, years known, title, and relationship CV State controlled substance certificate(s) Actions, medical conditions, substance & alcohol abuse Professional liability ECFMG certificate, if applicable

13 DOCUMENTATION Established Provider Access please Attest please Required information? Something missing? It s a team effort Not certified? Payer dependent Geographic area Need CME

14 PROVIDERS Licenses Degrees Internships Fellowships CV

15 MIDLEVELS Degrees Certifications Supervising provider

16 DEMOGRAPHICS & DOCUMENTS Organizing & Storing Paper files Scanned files Cloud Secure portals

17 ROSTERS THAT WORK MDs and DOs First Name Middle Designation Clinic(s) Supervising DOB SS# NPI IL License UPIN DEA CAQH # # CAQH User Name CAQH NPI User Password Name NPI Password Specialty Hospital Affiliation NPs PAs RDs RDs LCPCs Termed Provide rs

18 ROSTERS THAT WORK One Stop Shop TIN: Group MCR Part B Group PTAN Street Address City, State Zip Phone Number Fax Number Corporate Location 1 Location 2 Location 3 NPI Medicare Part A CLIA Providers Board Members Name Address

19 DOCUMENTATION Streamline when possible Assign roles Provider Enrollment Practice Liaison Electronically communicate upload back and forth Priority mail tracking and quick

20 CREATE YOUR PROCESS Create/Update NPPES Fill in applications Tag for signatures Create/Update & Attest CAQH Complete online requests Type instruction sheets Complete PECOS App Connect Provider to Organization PECOS /Mail paperwork to provider

21 DOCUMENTATION New Provider Start from scratch Apply for needed licensures CAQH application You need it all!

22 DOCUMENTATION Sample Provider 1234 Main Street CAQH Provider ID: Hometown USA Dear Sample Provider, At the request of one of the healthcare organizations with which you are contracted, or are in the process of contracting, please find enclosed the necessary information you will need to begin using CAQH ProView. CAQH ProView is an online provider data-collection service. It streamlines provider data collection by using a standard electronic form that meets the needs of nearly every health plan, hospital and other healthcare organization. CAQH ProView enables physicians and other healthcare professionals in all 50 states and the District of Columbia to enter information free-of-charge into a secure central database, then authorize healthcare organizations to access that information. CAQH ProView eliminates redundant paperwork and reduces administrative burden. This secure, online service has been provided to you by many of the nation's leading health plans and other organizations. A current listing of participating organizations can be found at How CAQH ProView Works: 1. Participating health plans and other organizations submit a request to CAQH to include you in this national initiative. 2. To register, log on to Link. 3. You complete one standard profile that meets the credentialing data needs of the dozens of participating organizations. 4. With your permission, participating organizations access your information and review it according to their respective policies and procedures. 5. You can update your information at any time and release your updated information to participating organizations.

23 DOCUMENTATION CAQH Complete info Upload documents Attest Sign here

24 TECHNOLOGY NEEDED?

25 TECHNOLOGY NEEDED? Software Enter information in software Sync with CAQH Bi-directional options Application automation Software is only as smart as the person who populates it and is utilizing it!

26 TECHNOLOGY NEEDED? Software Expiration reminders Reporting Productivity tracking Does it make sense?

27 TECHNOLOGY NEEDED? Manual CAQH data Audit it Track it Set reminders

28 GET READY, SET, GO! Compile information Complete Online requests Phone requests Applications Know your payers!

29 SIGN THIS Reserve a copy Attached for review Flag it Colors Keep it the same! Instructions included

30 GET READY, SET, GO! Submit Applications Fax Online Secure portals Mail it Tracking

31 FOLLOW-UP WHAT?

32 FOLLOW-UP WHAT? Software tasks Spreadsheets Payer Status Report Provider Roster , fax or phone? Fax Phone

33 FOLLOW-UP WHAT? Recredentialing Reattesting Set reminders

34 TIPS & TRICKS Automate Don t start from scratch Communicate with Reps 4 eyes = clean app Build relationships Honey versus vinegar

35 TIPS & TRICKS

36 LOCKED OUT EUS Contact Information: External User Services (EUS).PO Box San Antonio, Texas

37 LOCKED OUT

38 CONNECTIONS

39 CONNECTIONS

40 CONNECTIONS

41 CONNECTIONS

42 MEDICARE IN 1 DAY! Acquire authorization to represent Complete PECOS Medicare app Sign in as provider Electronically sign Select Electronic signature for organization Sign into your PECOS Electronically sign App complete!!!!!!!!!!!!!!!!!!!!!

43 PAPER APP GOING TO ELECTRONIC! Adobe Pro don t be cheap! PDF or paper app Scan it Create a form Print to PDF & save it! Security questions PECOS CAQH Address/demographics NPPES

44 KEEP IT SIMPLE! Don t Duplicate Convert forms to electronic Keep organization information Change what is needed Original Signature Not Needed? Have the provider sign form to you or /fax to payer

45 ANNUAL ROSTER RECONCILIATION Request a provider and site roster from all of your payers Identify termed providers Identify missing providers

46 PAYER RESOURCES Aetna/Coventry Healthlink Resource>Forms>nomination form Humana Cigna Call CIGNA UHC IL License Look-up censelookup.asp Health Alliance Complete PPI Request Form/Submit Copy of State application from CAQH and signed attestation. Medicare n.do#headinglv1 BCBS IL rk/join_bcbsil_network.html Anthem - MO mwpmf/pmfcontrollerservlet

47 NO TIME OR DESIRE? GIVE US A CALL AND LET US HELP YOU!

48 THANK YOU! CHASTITY D. WERNER, CMPE, RHIT, NCP (314)