CONTEXT / SCOPE
The purpose of this SOP is to provide the CSM with clear instructions and steps to ensure full understanding of the Credentialing Software and its respective modules and submodules. Having this knowledge will improve how CSMs provide their training sessions, as well as be more prepared for questions the admins will have.
IMPACTED TEAMS
Strategic CSMs
Core CSMs
GLOSSARY
ASC - Ambulatory Surgery Center
Board Certification - The process by which a physician or other professional demonstrates a mastery of advanced knowledge and skills through written, oral, practical, or simulator-based testing.
CAQH - Council for Affordable Quality Healthcare
CAQH ProView - The CAQH Provider Data Portal is the healthcare industry's premier resource for reporting professional and practice information to health plans and other healthcare organizations.
CRED SOFT - Self-Managed Credentialing Software (Credentialing Software)
CSM – Customer Success Manager
DEA - Drug Enforcement Administration
EIN - Employer Identification Number.
Exclusions - The result of an extreme sanction which is issued by the HHS OIG (Office of Inspector General). Exclusions are typically reserved for those who pose a high risk to patients or a program’s integrity.
FQHC - Federally Qualified Health Center
NPDB - National Practitioner Data Bank
NPI - National Provider Identifier
NUCC- National Uniform Claim Committee
OIG - Office of Inspector General
Payor (aka “Payer”) - A person, organization, or entity that pays for the care services administered by a healthcare provider.
Provider - A person or entity that provides medical care or treatment.
SAM - System of Award Management
SF - Salesforce
TIN - Taxpayer Identification Number.
TL - Team Lead
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Find what you’re looking for by training session number! |
TABLE OF CONTENTS
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Before the Training Session
Admin LMS Account Set-Up
Make sure that you have uploaded the completed Locations, Departments and Positions rosters into the system (these will be requested since your first email using the Welcome to MedTrainer! CSM Template available in Outreach). After that,
Ensure to send the admin the downloaded Employee roster from their account’s Employee Center. (this will be required in the Onboarding Call Recap email template) Once that is completed by the admin, you will be able to upload their employee lists with less issues.
Please make sure to send the following rosters to the admin:
ONLY for Standard and Premium AccountsView file name Credentialing Information Roster.xlsm
Ideally, the admin’s accounts can be set with their employees before training sessions. If this is not possible before then, simply remind the admin it is important to do so in case they would like assistance with initial setup. Please follow the Initial Organization Management Setup, and feel free to forward this file to your admins in its PDF form
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Remember to enter the “LMS Set-Up Completed Date” field in the Onboarding Object.
Your Demo Account Set-Up
The purpose of this is to:
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In order to provide more detail of several fields within the modules and their respective pages, you can advise the admin to hover over the following icon:
Preparing the Meeting
If your admin would like you to schedule the meeting on a specific date and time, review Options 1, 2 and 3 sections of the Onboarding SOP. -
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Locations
How to create and modify them
How to designate a location manager
Departments
How to create and modify them
Department Visibility
Positions
Both position databases (extended and generic)
How to create and modify them
Employee Center
Creating new users
Changing employee status
6 options under each user dropdown
Full profile walkthrough
Settings:
Organization Reports:
For accounts that purchased an integration: When the admins try to create employees manually from the employee center, they will see the warning message that remarks the risk of duplicated accounts or incorrect assignments. We want to encourage them to add the new employees only by the integration and to understand the possible consequences of doing manual creation. please refer to the MT-CS-018: SSO Services and HRIS Integrations SOP for more information.
Remember to let the admin know that NPI and SSN fields are now available in the full profiles.
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PART 1: The Organization Management Module
Preparation
Before creating any employees it is best practice to have the account foundation ready to make the rest of the organizational management process more efficient.
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Set verifications for any applicable documents, such as the DEA License Verification.
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Mandatory Documents
“Document needs vary based on the type of provider and insurance plan. Here are a list of base documents that may be needed:
Practitioner License(s)
Malpractice Insurance (Certificate of Insurance)
DEA (federal) and state CDS certificates
Board Certification(s)
Diploma – copy of highest level of education (required for non-MD’s,DO’s)
Current CV (showing current employer, and all entries have mm/yy format)
IRS Form W-9
Current driver’s license
Other documents that may be applicable:
ECFMG Certificate (if educated outside of The United States)
Passport or other citizenship documents (if born outside U.S. and not previously enrolled in Medicare)
Collaborative Agreement (required for Nurse Practitioners)
Admitting Arrangement letter (required for providers who do not have hospital admitting privileges)
Prescribing arrangement letter for providers not holding DEA certificate”
To learn more about documents providers need for credentialing, visit https://physicianpracticespecialists.com/credentialing/types-of-documentation-needed-for-physician-credentialing/.
Here, admins can set a list of documents that will be requested from providers:
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Location Documents
“Documents needed for your legal entity:
IRS form CP575 or replacement letter 147C (verification of EIN)
CLIA Certificate
Business License
Copy of office lease (required for therapy facilities)
Letter of bank account verification (for Medicare enrollment)”
To learn more about documents providers need for credentialing, visit https://physicianpracticespecialists.com/credentialing/types-of-documentation-needed-for-physician-credentialing/.
All practice location documents can be set here:
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OPTIONAL STEP FOR ADMINS: To set up Location Managers in advance (or if they haven’t been set up previously), go back to Organization Management - Locations, find the location you need, and click on this button: Here, you can add any of your Admins and Super Admins as Location Managers:  You can also enable manager notifications   Or delete admins  |
Organizational NPIs
“A National Provider Identifier(NPI) is a 10-digit numerical unique identifier and a Health Insurance Portability and Accountability Act (HIPAA) standard. NPI replaced the numerous different provider numbers previously issued by each payer with a single identifier that is used across all health plans.
There are 2 different types of NPIs; Type 1 (individual) and Type 2 (organizational). All clinical providers need to obtain a type 1 (individual) NPI number. This number will identify the provider who rendered services to a patient and needs to be reported on claim forms sent to payers.
Group practices that bill with a group tax identification number (TIN) should also apply for a Type 2, organizational NPI. This Type 2 NPI number should be used to complete enrollments with payers and for billing purposes. For group practices, individual providers' NPIs will be linked to the group NPI in the payer's system and both reported on claim forms submitted for reimbursement.”
To learn more about NPIs and TINs, visit https://support.drchrono.com/hc/en-us/articles/7117152502427-Individual-vs-Organizational-NPIs
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PART 2: The MT Credentialing Module
Visiting Individual Provider Profiles
Activating and Disabling Providers
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Switching Profiles
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Exclusions
“An exclusion is a provision within an insurance policy that eliminates coverage for certain acts, property, types of damage or locations. Things that are excluded are not covered by the plan, and excluded costs don’t count towards the plan’s total out-of-pocket maximum.“
To learn more, visit https://www.healthinsurance.org/glossary/exclusion/
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A lot of our clients use a platform called CAQH, where they have similar information fields filled in for their providers. In order to migrate the information into our platform, they will need the following:
Once these requirements are completed, the button will become enabled.
To learn more about CAQH and how it is involved in the MedTrainer credentialing process, visit:
Enrollments
“Provider enrollment is the process of registering with an insurancenetwork to become an approved provider and receive reimbursement for services provided to patients covered by that network. It involves submitting an application and supporting documentation, such as proof of licensure, malpractice insurance, and education and training credentials.“
To learn more about enrollments, and how they are different from provider credentialing, please visit https://physicianpracticespecialists.com/credentialing/provider-credentialing-vs-provider-enrollment-understanding-the-difference/
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Information - Main enrollment details, and additional information about the enrollment workflow, the provider, and the lines of business. There are also important timeline and date fields at the bottom.
“Line of business, in the realm of commercial insurance, refers to a specific category or type of insurance coverage that is offered to businesses or individuals within a particular industry or sector. It represents a distinct area of insurance that is tailored to address the unique risks and needs associated with a specific line of work or business activity.“
To learn more, visit https://foundershield.com/insurance-terms/definition/line-of-business/
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Lastly, the Dashboard tab provides us with a status summary on: Documents, Verifications, Enrollments and Enrollment Tasks. The graphs shown are also hyperlinked to each of their respective sections of the provider profile, for quick access.
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Company Settings Part 1
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Training Session 2 |
Admin Dashboard
This dashboard provides an overview on all credentialing stats (including Notifications and Tasks) and has two main action buttons: “+New Enrollments” and “Activate Providers”.
Please give the admin a full overview of what shows below:
Notifications
Tasks (new tasks can be created here)
Documents (hyperlinked)
Enrollment Status (hyperlinked)
Verifications
Licenses
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Admins can active providers directly from their dashboard, they will be redirected to the provider profiles dashboard.
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Please keep in mind that the admins will be able to access the rest of the submodules directly from the Admin Dashboard, as they are linked.
Provider Profiles Dashboard
In the Provider Profiles dashboard, the admin can:
Disable active provider profiles
Enable provider profiles
View any terminated provider profiles
Pull reports per active provider and all active providers
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Privileges and Appointments
“Hospital privileges give doctors authorization to practice at and admit patients to a particular hospital. These privileges allow physicians to perform specific procedures like surgery and must be awarded by every hospital where a doctor wants to practice in.
Types of hospital privileges
There are three main categories of hospital privileges:
Admitting privilege authorizes a physician to admit patients to a particular hospital without the need for the patient to go through the ER first. Physicians with admitting privileges are able to treat their patients within the hospital and work alongside hospital staff when need be.
Courtesy privilege authorizes a physician to admit, but not necessarily treat, patients at a specific hospital. Generally, courtesy privileges are used by physicians to visit admitted patients regarding their medical care.
Surgical privilege authorizes physicians to perform outpatient surgeries and to book the hospital or surgery center’s operating room.”
Hospital privileges and hospital credentialing sound similar, but they are indeed two different processes. Hospital credentialing must happen before you apply for hospital privileges.
During this credentialing process, the medical facility will focus on ensuring that you are able to provide competent and safe patient care. To do so, hospital bylaws will be consulted and you will be required to provide proof of your education and medical training. “
To learn more about privilege appointments and reappointments, visit https://support.drchrono.com/hc/en-us/articles/7117152502427-Individual-vs-Organizational-NPIs
This dashboard shows an overview of all the existing privileges and appointments applicable to the providers. Admins and Super Admins will be able to generate new appointments here as well.
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Documents
This module shows an overview of all document stages, and will also let the admin upload any missing documents, or update any expired ones:
By selecting each document, they can both upload a new document version, or go to the provider’s profile.
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Files Staging Area
This module allows the user to submit documents into provider profile in one place, making the provider documents upload/update process more streamlined. It has a similar functionality to the In-App reports. Please go over it with the admin.
The Logs button will take the user to the Logs Report in the Credentialing In-App Reports.
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Enrollment Applications
Here, the admin will be able to filter and visualize all enrollment applications initiated, as well as: view details, delete or view activity logs.
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Feel free to share the https://drive.google.com/file/d/1mdD4J8HyY1DyCs-GWQo5xCywWYWYcUzv/view?usp=sharing with your admins. |
Credentialing Dashboards
This dashboard provides a summary on the following regarding enrollment applications:
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The goal is to give the admin full visibility of what is happening, as well as notice trends and outliers.
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Insurances
This module simply summarizes the list of Insurances linked to the account’s Practice Locations:
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Business Entities
“In simplest terms, a business entity is an organization created by an individual or individuals to conduct business, engage in a trade or partake in similar activities. There are various types of business entities — sole proprietorship, partnership, LLC, corporation, etc. — and a business's entity type dictates both the structure of that organization and how that company is taxed.“
To learn more, visit https://www.nerdwallet.com/article/small-business/business-entity
This dashboard will let admins and super admins manage and create new business entities:
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Locations
Though we mentioned this module in part 1, admins are able to do much more:
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Multiple setup:
Adding multiple verifications
Adding multiple documents
Enabling insurances in multiple locations
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Credentialing (In-App) Reports
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Reports, Settings and Company Settings
Reports
A couple of these reports are still active in several accounts, but remember that the main goal is to get our admins to migrate into the In-App reports fully.
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Settings
Simple changes like enabling email notifications, changing the company name and address, and updating the super admin’s password.
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Only super admins will be able to see billing information at the bottom of the screen. |
Company Settings
These help our admins tailor out how they want their LMS accounts to work. Remember to go into module-specific settings here:
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This module basically provides quick detailed access to detailed exclusion-related information. The submodules are the following:
Matches for Individuals
Any matches found for providers can be seen here:
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Employee and Location Defaults
If the admins want to run exclusion checks for all staff (not providers only), they will be able to configure that here. They will also be able to set exclusions per credentialing (practice) locations:
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Current Employee Settings
Admins will be able to configure specific exclusions per provider here:
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Notifications
This submodule will simply help configure enrollment notifications:
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Exclusions (In-App) Reports
We will be retracing the steps on Credentialing (In-App) Reportssection.
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After the Training Sessions
A Recap for the Attendees
Once the training session has been completed, send a email using the Outreach Training Recap Outreach Email Template immediately after the training session recording has been processed (or at least before the end of day), and fill in necessary information such as:
Participants
Modules
Pending Subjects
Relevant Links
Our Customer Support Department
It is paramount to not only encourage, but reinforce the admin on the use of our Customer Support Department. Provide the contact information below:
Email: support@medtrainer.com
Phone number: 844.596.6553
The Support Module in the MedTrainer platform.
Other Training Sessions
If the account acquired the Learning and/or the Credentialing Software Modules, please refer to any of the following SOPs:
Adoption: The Next Steps
Lastly, please refer to the https://medtrainer.atlassian.net/wiki/pages/resumedraft.action?draftId=4135616513&draftShareId=a3711c8d-3de8-4bf5-95fb-6db42e50e83c, in order to continue with the account adoption following the instructed guidelines.
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