Credentialing
Risk Management & Credentialing
Licensing, Privileging, Enrollment, and Credentialing (LPEC) Strategy
- Implement, Monitor, and Maintain LPEC Strategy – Full data analysis of the organization.
- Completion of credentialing & re-credentialing applications and database attestations –payer and state-mandated applications.
- Preparation for primary source and reference verifications – this allows the health plans and facilities to efficiently process verifications by having the right contact information the first time.
- Confidential electronic storage of required credentialing documents (state license, DEA, CE/CME’s curriculum vitae, malpractice, certifications, etc.)
- Progress Tracking & Credentialing Updates
Licensing
- Taxonomies
- Specialties
- State License(s)
- Board Certifications
- DEA
- FDA
- Federal Verifications & Backgrounds Screenings Including Pacer, OIG, SAM, NSOS
- ECFMG
- Identify Verification
- Internship
- Residency
- Fellowship
- National Physician Database
- Insurances: Professional Liability & Malpractice
Enrollment
- Payor Enrollment
- Medicare - PECOS I&A
- Medicare Advantage Plans
- Medicaid Provider Numbers
- Medicaid Managed Accounts
- Provider Network Applications
- Appeals
- CAQH -Update Profiles & Quarterly Attestations
- NPI Application(s) and /or update NPI profile(s)
- Re-credentialing providers & managing re-credentialing dates
- Adding new service location(s)
- Revalidating Medicare and Medicaid
- Obtaining copies of Contracts & Fee Schedules
- Updating Network Directories
- Removing Reassignments
- Licensing (new/renewal)
- DEA/CPS - Controlled Substance Practitioner Registration (new/renewal)
- Managing and reporting expirables, including re-credentialing dates, hospital privileges, licenses & DEA
Privileging
- Hospital, Skilled Nursing Facility, Ambulatory Surgical Center, etc.
- Privileging package creation, audit, and verifications
- Completed Delineation of Privileges Form
- Completed Locum Tenens Practice Experience Form (if applicable)
- Work history including all practice locations and employment affiliations
- Current Curriculum Vitae with complete professional history in chronological order and no gaps (month and year must be included)
- Case log from the last 24 months (If applicable)
- Copy of college/university diploma and training certificate(s)
- Current CME (CME activity for the past three years)
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