Medicare Provider Credentialing & Enrollment 101: Guide To Enrollment and Credentialing

Session Overview

Did you know that credentialing and payer enrollment are foundational elements in launching your organization’s revenue cycle? These processes ensure your providers are correctly enrolled with payers and are eligible for in-network reimbursements. Enrolling with payers involves detailed steps that must be carefully managed to avoid delays or interruptions in revenue flow. Managing provider profiles, directories, and network portals requires accuracy and consistent updates. Overlooking any part of this process can disrupt network participation and negatively impact your financial performance.

In this session, industry expert Yesenia Servin, CPMSM, PESC, will guide participants through the complexities of provider enrollment, revalidation, and attestation. She’ll also provide insights into how these areas affect your organization’s revenue integrity. This session includes an in-depth look at commonly used enrollment portals and forms, along with strategies for managing them efficiently.

Medicare Enrollment Focus

Participation in the Medicare program involves the use of various CMS-855 forms, which differ depending on the type of provider or healthcare entity. These forms are extensive, detailed, and require ongoing maintenance. Large organizations—such as integrated health systems or multi-specialty groups—often manage hundreds of these forms. Keeping them up-to-date is critical to avoid processing delays or denials.

Yesenia Servin will offer a detailed walkthrough of the CMS-855 enrollment forms, including paper and PECOS applications. The session will also address the distinctions between individual, facility, and organizational applications. Participants will learn how to avoid common errors that lead to form rejection and enrollment delays.

Key Learning Outcomes

• Understand how to stay compliant with CMS enrollment requirements

• Navigate Medicare provider enrollment using CMS-855 forms

• Distinguish between Part A (facility) and Part B (organization and individual) applications

• Learn how to handle provider reassignments

• Explore updates and common misinterpretations of CMS-855 forms

• Review the PECOS system and its application components

• Understand specific requirements of both government and private payers

Topics Covered

• Credentialing and provider enrollment fundamentals

• Steps to join payer networks

• Pre-application processes and network screening

• Application submission and network agreement

• Maintaining provider profiles in CAQH and other platforms

• Managing the credentialing workflow from discovery to approval

• Key platforms and tools: I&A, NPI, NPPES, PECOS, CAQH

• Understanding fee schedules and CPT code listings

• Delegated vs. non-delegated credentialing models

• Building and maintaining your credentialing database

• Employment history and expirable credentials tracking

• Accessing payer portals (e.g., UHC, Cigna, Availity)

• Communication tracking and follow-up strategies

Who Should Attend?

• Who will Benefit:-
  • Credentialing Specialist
  • Revenue Cycle Managers
  • Enrollment Specialist
  • Hospitals
  • Mental Health Providers
  • LCPC
  • LMFT
  • Practice, Clinic Owners
  • Hospital Leadership
  • Authorized Officials
  • Delegated Officials
  • Revenue Cycle Directors
  • Credentialing
  • Office Manager
  • Revenue Cycle
  • Operations
  • Billing Team
  • In and Out of Network Providers
  • Medical Billing Companies
  • Providers Office Staff
  • Physician
  • Hospitals and Facilities
  • Insurance Companies
  • Healthcare Attorneys
  • Executive and Administrators
  • Front Desk
  • Scheduling
  • Authorizations Staff
  • Medical Assistants
  • Certified Nursing Assistants