Medicare Provider Credentialing & Enrollment 103 : Guide To Enrollment and Credentialing

Overview

Comprehensive Walkthrough of CMS Identity & Access and NPPES Processes

Navigating the CMS National Plan and Provider Enumeration System (NPPES) can be challenging due to its intricate interface and complex requirements. Maintaining accurate, up-to-date provider information is critical—not just for obtaining a National Provider Identifier (NPI), but for ensuring compliance and avoiding costly delays. Whether you’re managing a single provider or an extensive roster, this training, led by credentialing expert Yesenia Servin, CPMSM, PESC, offers the clarity and tools needed to streamline the process.

This session will cover each step involved in setting up and maintaining NPPES and CMS Identity & Access (I&A) accounts, along with practical strategies to resolve common issues such as application rejections or claim discrepancies.

Key Discussion Points

• Ensuring accuracy in taxonomy codes

• Troubleshooting application rejections or denials

• Addressing claim issues when you’re approved in-network but processed as out-of-network

Learning Goals

• Establish, maintain, and attest NPPES and I&A accounts

• Accurately complete enrollment forms for payers

• Understand and execute follow-up procedures for enrollment submissions

• Identify payer-specific application and submission requirements

• Locate appropriate payer contacts and submission details

• Track the status of enrollment applications effectively

• Build a secure I&A account to access CMS platforms like PECOS and NPPES

• Use the CMS surrogacy function to manage multiple NPPES accounts through one login

• Register new NPPES accounts correctly from the start

• Manage several NPI profiles efficiently within one account

• Gain a solid understanding of provider specialties and taxonomy codes

Who Should Attend?

This session is ideal for professionals involved in credentialing, provider enrollment, and practice operations, including:

• Practice Managers

• Credentialing Coordinators (PESC, CPMSM)

• Revenue Cycle Specialists

• Directors and Executives

• Chief Financial Officers (CFOs)

• Provider Enrollment Staff

• EFT and Operations Teams