Fast Track Your Enrollments: Demystifying CAQH, I&A, PECOS & NPPES for Providers

Course 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
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
- Initial Enrollment
- Revalidation
- Changes of Information (CHOI & CHOW)
- Setting up Provider record or the Organizational record
- Ensuring continued compliance with Medicare Program
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)

Suggested Attendees:

Payor 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
Office Managers
Operations
Coders
Clinical Directors
Practice Owners
Claims Teams
MSPs

About the Presenter:

Larry DeHoyos, CPCS, PESC, is a thought leader and innovator with more than 24 years working experience as a Medical Staff Professional. He is nationally certified as a Provider Credentialing Specialist and also holds certificates in Provider Enrollment and as a Transformational Healthcare Champion. His expertise spans all 50 states within a multitude of healthcare spaces including Health Plan, Managed/Specialty Care, Outpatient/Surgical spaces, Laboratories and most recently within a Healthcare Staffing Agency as Director of Credentialing for a per diem staff network of over 32,000 nursing professionals. Larry’s knowledge and experience sets his intent outside of the bounds of the industry and focuses on helping organizations solve challenges in process, technology and compliance within Credentialing, Provider Enrollment, Revenue Cycle and Accreditation Readiness. He is an active member with the National Association of Medical Staff Services and state and local chapters for California, Massachusetts and Texas. He has spoken on various industry topics for platforms as McKnight’s Long Term Care News, NAMSS, National Provider Enrollment Forum, and various State and Local Associations of NAMSS.

Additional Information:

System Requirement:

Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

Snippet From Our Previous Session:

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