Credentialing and payer enrollment are the fundamental gears that drive the revenue cycle of any healthcare organization. Provider Enrollment is the precise, payer-specific process required to enroll your organization and individual providers for in-network participation. This in-network status is the gateway to receiving appropriate reimbursement for services rendered.

This process is a complex engine with many moving parts that must be managed meticulously, as your organization's financial health depends on its smooth operation. It requires the successful and continuous maintenance of multiple provider profiles, online directories, and network portals. Any missed step—from initial application to timely revalidation—can jeopardize a provider’s network status and, consequently, halt your revenue stream.

This essential session, led by expert Yesenia Servin, CPMSM, PESC, will deconstruct the entire provider enrollment lifecycle. We will analyze the most common web portals and forms, providing a clear roadmap for managing them successfully. Attendees will gain a deep understanding of enrollment, revalidation, and attestation and their direct impact on your bottom line.

A critical component of this process is enrolling with the Medicare program via the various CMS-855 forms. These lengthy and detailed forms are often confusing, and they must be filed accurately not just initially, but also maintained and updated throughout a provider's career. For large health systems or multi-specialty clinics, this can mean managing hundreds of these dynamic forms. Failure to use the correct, updated version can lead to outright rejection and significant payment delays.

Join Yesenia Servin, CPMSM, PESC, for a detailed review of the CMS-855 forms for Medicare participation. This webinar will provide a comprehensive analysis of both paper and PECOS applications, including Facility (Part A), Organization, Individual, and Reassignment applications.

Learning Objectives

Upon completion of this webinar, participants will be able to:

• Navigate the CMS ecosystem to remain compliant and successfully complete Medicare provider applications.

• Differentiate between and complete Part A Facility, Part B Organization, and Individual applications.

• Understand the purpose and process for reassignment applications.

• Confidently guide a provider through the Medicare enrollment process using the correct CMS-855 forms.

• Implement processes to address changes to the forms and evolving regulatory interpretations.

• Manage the mandatory revalidation process for all CMS-855 forms.

• Navigate each section of the application within the PECOS online portal.

• Identify and adhere to the specific rules and requirements for both government and commercial payers.

Areas Covered in the Session

• Fundamentals Defined: Credentialing vs. Enrollment

• The Network Journey: A step-by-step walkthrough from pre-application to final determination (INN or denial).

• First Action Steps:

  • Establishing Entity Names, TIN vs. SSN

  • Setting up Identity & Access (I&A) Management

  • Managing NPI, NPPES, CAQH, and Specialty Designations

  • Understanding CPT Lists and Fee Schedules

• Deep Dives into Key Systems: I&A Accounts, CAQH, and NPI

• The Discovery Phase: Understanding the Why, Who, Where, and When of enrollment data.

• Mastering Portals & Profiles:

  • Payer Network Portals (UHC, Cigna, etc.)

  • Government Portals (PECOS, NPPES)

  • Private, Hospital, and Clearinghouse Portals

• Delegated vs. Non-Delegated Models

• Building Your Own Credentialing Database: Practical guidance using Excel, Access, or OneNote.

• Managing Critical Data: Employment history, contract details, login information, and expirable data.

• Essential Connections: Gaining and managing access to CMS Access Manager, Availity, and key payer platforms.

• Live Q&A Session with expert Yesenia Servin.

Who Should Attend?

This webinar is critical for all professionals involved in the provider and revenue lifecycle, including:

• Credentialing & Enrollment Specialists

• Revenue Cycle Managers, Directors, and Teams

• Practice, Clinic, and Hospital Owners & Leadership

• Authorized and Delegated Officials

• Office and Operations Managers

• Billing Company Staff

• In and Out-of-Network Providers

• Front Desk, Scheduling, and Authorizations Staff

• Medical Assistants and CNAs

• Healthcare Attorneys and Consultants

• Insurance Company Personnel