Payer Enrollment
What is needed for a provider to move forward with enrollment?
What is licensures?
A new provider notice is received. What are the first three actions that should occur before sending the welcome email?
What are creating the I Drive folder, creating/updating the Symplr Provider Profile, and completing the PES Outreach Call/Checklist?
NEO
New Employee Orientation
This system houses onboarding folders, payer files, and enrollment documentation.
What is IDrive?
This document demonstrates successful completion of medical school, nursing school, or another professional healthcare program.
What is a diploma?
Providers must complete this action every 60-120 days.
What is CAQH attestation?
A provider has not responded to your welcome email or PES outreach. What is the biggest risk if this is not escalated quickly?
What is delaying the collection of onboarding and credentialing documentation?
CMS
Center for Medicare and Medicaid Services
This system houses provider folders, onboarding trackers, and enrollment updates.
What is SharePoint?
This documentation is often requested when a provider's board certification is not yet available.
What is a Letter of Standing/Board Eligible?
What does a Certificate of Insurance (COI) cover?
What are malpractice lawsuits.
A provider's documentation deadline is approaching. Name two places where this deadline should be tracked.
What are the Provider Onboarding Tracker & SharePoint Calendar?
NPI
National Provider Identifier
This system receives provider profile updates, document uploads, and enrollment information.
What is Symplr?
A provider completed residency training but cannot produce a residency certificate.
Why is this a concern during onboarding?
Residency training must be verified as part of the provider's qualifications.
At least one of these enrollments must be completed before triggering Symplr payer enrollment.
What is Medicare or Medicaid?
A provider is onboarding at three clinic locations.
What information must be identified early to avoid downstream delays?
What is the primary location and all additional locations.
BCS, ACLS, & PALS
Basic Life Support, Advanced Cardiovascular Life Support, & Pediatric Advanced Life Support
After a provider's start date is confirmed, this national database should be updated.
What is the NPPES NPI Registry?
A provider's state license allows them to practice medicine, but this credential demonstrates they have met specialty-specific standards and passed a specialty examination.
What is Board Certification?
A provider starts in 45 days. All licensures have been received, but no government or commercial enrollments have been initiated. What process should already be in progress and what is the primary risk?
Payor enrollment should already be underway, putting enrollment approvals and revenue readiness at risk.
A PA provider is onboarding. The provider's file is complete, but one onboarding document is still missing.
What is the Supervising Physician Letter?
CAQH
Council for Affordable Quality Healthcare
This system is used for provider builds.
What is Epic?
A provider's NM license, DEA, CSR, ACLS, and PALS are all current, but their Board Certification has expired.
Why is this important during credentialing and payer enrollment?
Board Certification may be required for privileging, payer participation, & specialty designation.