Credentialing Ticket Routing
When receiving a Cred question you cannot solve (and you are not part of the specialization), where should the ticket go?
Transfer to CC Cred Specialization using the macro [General] Transfer to CC Cred Specialization.
What types of questions commonly get transferred to the CC Cred Specialization?
Credentialing questions not tied to Atlas tasks, MSC rate questions, payer eligibility, recredentialing, and Evernorth MOS recruitment questions.
What types of payer credentialing issues should be escalated via Ops Jira?
Questions for a specific payer about delays, communications, opting in, or depaneling non-delegated plans that are not covered in SBSS
Which issues should be transferred to Cred Docs rather than escalated?
License issues, document upload issues, or questions tied to open Atlas tasks — after confirming they are not self-serve.
Where should unclear SOP questions be posted after informing your SME?
#cred-spec-smes on Slack.
What is the golden rule for moving tickets into a different Zendesk group?
Always use a transfer macro — NEVER manually change the assignee group.
If you're part of Cred specialization but can’t self-serve a solution, what is the next step?
Create an Ops Jira ticket for Cred following the SOP.
Which Jira project and issue type must always be selected for Cred tickets?
Project: Operations
Issue type: Providers
Which types of problems should not be escalated through the Cred Zendesk → Jira workflow?
Any Ops requests unrelated to Credentialing.
If a provider asks about payer eligibility that is not covered in SBSS, what do you do?
Escalate using the Cred Ops Jira workflow.
Name two issue types that should be transferred to the Cred Docs team.
– Questions about an open Atlas task
– License issues or issues with documents at intake
Should recredentialing questions always be escalated?
No — always check first, as many answers are in the SOP.
True or False: You may ask for Cred timelines for Optum in a Jira Ticket.
False — Review the SOP to check if a provider is off the waitlist, if not, we do not have any timeline to share.
A provider is not DPSR and claims cannot be submitted. Should this be escalated?
Yes — Cred specialization should escalate via Ops Jira if it cannot be self-served and is credentialing-related.
What must you never copy-and-paste into a Jira ticket?
The Zendesk ticket body — rewrite issue details in bullet points.
Which macro should be used for transferring documentation-related issues to the correct cross-functional team?
[General] Credentialing documentation, Transfer to XFN team (public reply).
If you believe an SOP or SBSS section is unclear, what must you do first?
Flag the issue to your SME, who will then engage #cred-spec-smes.
What must you ALWAYS fill out in the Jira ticket?
License States
Provider Atlas Link
Provider NPI
What should you ensure before transferring a ticket related to intake documentation issues?
Verify whether it is self-serve by reviewing intake troubleshooting guides.
Which Jira field stores the provider’s identification used in credentialing workflows?
The Provider NPI field.
A provider uploads a COI with the wrong name or incorrect amounts. Where should this ticket be routed?
To the Cred Docs team, after confirming it is not self-serve.
A provider tags a ticket as Credentialing, but the issue is client eligibility. What should you do?
Transfer using the macro [General] Transfer to ONSHORE Other reason (public reply).
True or False: You should select the Benefits & eligibility option to check payer eligibility for a provider.
False - the benefits & eligibility team does not handle benefit verification requests or credentialing questions.
If a provider has multiple profiles or a “deceased provider” flag, where does the ticket go?
Escalate via Ops Jira — these are non-self-serve credentialing issues.
What is the final action required to submit the Jira ticket?
Clicking the blue “Create Issue” button — which automatically links Jira + Zendesk.