Cred Specialization Rules
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.
If a provider asks about payer eligibility that is not covered in SBSS, what do you do?
Escalate using the Cred Ops Jira workflow.
Can offshore agents terminate a provider’s state?
No — offshore agents do not terminate states.
Where do you start when creating a Jira ticket for Cred from Zendesk?
Click the “+” icon → choose “Create issue.”
What factors determine a provider’s rates on Headway?
A provider’s license type, credentialed state, practice region (if applicable), and insurance carrier/plan type.
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.
What must you never copy-and-paste into a Jira ticket?
The Zendesk ticket body — rewrite issue details in bullet points.
If a provider asks how to terminate a state, what should offshore agents do?
Escalate the question to onshore support.
Which Jira project and issue type must always be selected for Cred tickets?
Project: Operations
Issue type: Cred Specialization
Where can providers view their Headway contract and rates after joining?
On the Rates & Agreements page in Sigmund.
Should recredentialing questions always be escalated?
No — always check first, as many answers are in the SOP.
Which Jira field stores the provider’s identification used in credentialing workflows?
The Provider NPI field.
Can offshore agents complete or update tasks in the Tasks tab?
No — tasks should never be completed by offshore agents.
True or False: You may update the “Reporter” field when creating the Jira ticket.
False — never update the Reporter field.
What must an existing provider do to credential in an additional state?
Complete a new intake form, which also functions as a re-credentialing form and pre-populates prior information.
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 resource should you use when reviewing state requirements for licenses and credentialing timelines?
State by State Playbook
Can offshore agents troubleshoot or resolve CAQH issues directly?
No — all CAQH-related inquiries must be escalated to onshore.
What must you ALWAYS fill out in a Cred Jira ticket, even if the question is not about a payer?
The Payer name – Cred field (select N/A if not payer-related).
What should you verify in Atlas before confirming whether a provider is eligible to credential with a payer in a specific state?
Verify the provider’s license type, state of licensure, and whether they have a completed intake form for that state.
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: Offshore agents can update provider information directly in CAQH.
False
What should you always use when routing a ticket in Zendesk?
A transfer macro — never manually change the assignee group.
What happens if you choose the wrong Jira project or issue type?
The ticket will be closed automatically.
A provider asks why they can’t confirm appointments for a client in another state. What is the most likely blocker you should check first?
Whether the client’s address and virtual session location match a state where the provider is licensed and credentialed.