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CATEGORIES:Credentialing Certification for Rural & Community Health
SUMMARY:Credentialing Certification for Rural & Community Health
DESCRIPTION:
Credentialing is the process
by which insurance carriers, facilities, and hospitals verify that a medic
al provider meets various quality and regulatory standards. Entities do thi
s by reviewing items such as an applicant’s education, medical licensure, s
tate and federal registrations, certifications, professional liability cove
rage, as well as many other documents. This time-consuming task requires pr
ecise attention to detail and follow through. ArchPro’s credentialing team
will ensure that your organization's credentialing files are completed wit
h accuracy and in compliance with regulatory and accreditation standards.
div>
Enrollment refers to the process of requesting participation in
a health insurance network and <
/span>submitting required documentation to third party payers to gain appro
val into payer networks and allow providers to bill for services.
Objectives: This certification is designed to increase your
knowledge and competence in the credentialing and enrollment process. You will be able to demonstrat
e your knowledge, skills, and abilities in the credentialing processes for
your organization as well
as effectively navigate the provider enrollment process.
Pri
mary Audience: Credentialing Staff
Benefits: Credentialing staff will have the knowledge to:
- Perform creden
tialing functions to meet documentation guidelines for compliance with regu
latory standards and accrediting bodies
- Credential physicians, alli
ed health and other practitioners
- Collect and maintain an accurate
practitioner database and analyze verification information
- Direct c
redentialing processes
- Participate in audits of practitioner files
for compliance
- Collaborate with the organizations medical staff to
develop and maintain facility specific credentialing standards and procedur
es
- Understand payer requirements
- Understand mistakes to avo
id that delay payer enrollment
- Understand how to navigate the payer
enrollment process
Section Breakdown:
- Credentialing overview
- Committee and Staff Structure
-
Provider Credentialing
- Primary Source Verification
- Creden
tialing Committee Process
- Provider Recredentialing
- Privi
leges
- Ongoing Monitoring and Compliance
- Telemedicine
- CMS Regulations
- Meeting Minutes
- Fair Hearings
<
li>File Audit - Additional Requirements-Payer
- Key Legal Cas
es
- Putting it all together
- Payer Enrollment Content
ul>
DTSTAMP:20240329T092258
DTSTART;TZID=America/New_York:20221005T090000
DTEND;TZID=America/New_York:20221005T153000
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