Credentialing 101: A Detailed Guide to Provider Credentialing

Course Description:

Credentialing 101: A Detailed Guide to Provider Credentialing is a foundational training session designed for professionals entering the world of healthcare provider credentialing. Whether you’re onboarding your very first provider or expanding your services across multiple states and specialties, this webinar will equip you with a comprehensive understanding of the credentialing lifecycle.

Participants will gain in-depth knowledge on how to prepare and submit credentialing applications, understand payer requirements, and navigate the varying processes based on provider types including mental health professionals, optometrists, allied health professionals, medical doctors, facilities, and ancillary services.

We'll break down the essentials of insurance panelling, such as how to set up and maintain CAQH profiles, utilize NPPES for NPI data, register and navigate PECOS, and manage key portals like Availity. You’ll learn how to interpret insurance terminology, track credentialing progress, and work effectively with insurance representatives—distinguishing between national carriers, local HMOs, and union plans.

This course emphasizes strategic planning, communication with clients, compliance best practices, and smart use of software tools to ensure credentialing stays organized, timely, and successful. We’ll also explore how credentialing professionals can think outside the box, identify IPA opportunities, and stay current with evolving insurance guidelines.

Learning Objectives:

Understand the complete provider credentialing process and its phases
Identify and explain key terms, systems, and documents involved (e.g., NPI, CAQH, PECOS, Availity, W-9, malpractice insurance)
Recognize how credentialing requirements vary by provider type (e.g., behavioural health vs. vision vs. facility-based care)
Navigate multistate credentialing and licensing considerations
Distinguish between insurance types (local HMO, national plans, and unions) and understand who the reps are
Establish and maintain strong communication with clients and payer reps to manage expectations and streamline credentialing timelines
Build a credentialing plan of action with due dates and progress tracking methods
Leverage technology and software tools to organize, automate, and monitor credentialing workflows
Stay current with insurance news and updates to reduce denials and anticipate changes
Learn what to avoid during credentialing and common pitfalls that delay approvals

Areas Covered in the Session:

Credentialing Basics: What is credentialing and why it matters for in-network status
Key Systems & Documents: Understanding NPI (Type 1 & 2), Tax ID, CAQH, PECOS, W-9s, and Availity registration
Credentialing Phases: Intake, application prep, submission, payer follow-ups, and contract receipt
Specialty-Based Variations: Key differences in credentialing workflows for MDs, therapists, optometrists, facilities, and DME providers
Multistate Credentialing Tips: Licensure rules, Medicaid enrollment strategies, and managing overlapping timelines
Understanding Insurance Types: Comparing national plans (e.g., UHC), local HMOs (e.g., Fidelis), and union plans (e.g., 1199)
Client Communication & Expectation Management: Setting up a transparent timeline and consistent updates
Insurance Representatives 101: How to locate reps, build rapport, and understand the payer’s internal hierarchy
Common Mistakes to Avoid: What you can’t do—e.g., using incorrect NPI types, wrong group vs. individual applications, etc
Tools & Technology: Credentialing CRMs (e.g., CredyApp, Modio, CAQH ProView), spreadsheets, portals, and reminders
Staying Current: Best practices for tracking payer updates, newsletters, industry alerts, and government guidelines
Thinking Outside the Box: Strategic planning—adding new plans, exploring IPA relationships, and creating credentialing roadmaps
Live Q&A Session

Suggested Attendees:

Credentialing and Enrollment Specialists
Credentialing and Enrollment Experts
Credentialing and Enrollment Leaders
Healthcare Administrative Teams, Personnel
Practice Managers and Administrator
Healthcare Billing Specialist
Staff Providing NPI Support, NPPES Support
PESC, CPMSM, CPCS
Staff Providing CAQH Support
Clinic Managers
Allied Health Providers
Advance Health Practitioner
Credentialing
Enrollment
Office Managers
Operations
Revenue Cycle
Coders
Clinical Directors
Practice Owners
Claims Teams
MSPs

About the Presenter:

Alina Mineyli is the Senior Credentialing Specialist at WCH Service Bureau, Inc., with extensive expertise in insurance credentialing, contract negotiations, and provider enrollment. She specializes in securing provider enrollments, managing re-credentialing, and resolving closed panel challenges for a wide range of healthcare providers, including multi-specialty groups, laboratories, pharmacies, and DME suppliers.

A strong advocate for healthcare rights, Alina has successfully negotiated contracts, facilitated reinstatements, and streamlined credentialing processes, ensuring providers can expand their networks and deliver quality care. Her strategic approach and in-depth payer knowledge have strengthened WCH’s credentialing services, making her a trusted partner in payer-provider negotiations.

She graduated with a Bachelors of Arty in behavioural Neuroscience and Medical Interpreter in the Hunter College of the City University in new York.

Additional Information:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

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

Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

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