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

TABLE OF CONTENTS

Before the Training Session

Admin LMS Account Set-Up

1. 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,

2. 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.

3. Please make sure to send the following rosters to the admin:

   • https://docs.google.com/spreadsheets/d/1P6Xjx5rrZt_ytsQ44TirOfj6TXi0V_yr/edit?usp=drive_link&ouid=110045133522799162123&rtpof=true&sd=true

   • https://docs.google.com/spreadsheets/d/1Y2L2KZF0bib6tEmIacQnIlL_ftV2uJGN/edit?usp=sharing&ouid=110045133522799162123&rtpof=true&sd=true

   • ONLY for Standard and Premium Accounts

3. 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:

• Ensure you are is familiar with the system, performing all the possible tasks in each module.

• Showing the admin how the system looks real time, with populated data.

• Leaving the admin’s account as a clean slate to use from scratch.

Make sure to have:

• Providers and Practices Locations with Credentialing Enabled

• Uploaded test documents for at least one provider

• Enrollments, Verifications, Mandatory and Location Documents in at least one Practice Location.

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. -

• Option 1: Outreach Platform

• Option 2: Outreach Everywhere Extension

• Option 3: Google Calendar

If the admin hasn’t scheduled a training session yet, please send proposed times as shown in the Option 4: Gmail (Inserting Proposed Times) section of the Onboarding SOP.

We need to have the training sessions logged into the corresponding SF account, and confirm that the meeting also appears scheduled in Gong so that it can be recorded. You can check in Gong if your meeting appears once you click on the “View upcoming calls” section. It should appear if the process was followed. If this is not the case, please perform the following steps:

Open

Organization Management Training

If this is the first training session with your admin, provide Organization Management training covering the following topics (it is suggested to follow the steps on the https://medtrainer.atlassian.net/wiki/spaces/CSKB/pages/4154654777 ,  as it follows the recommended setup order. Feel free to forward this file to your admins as well):

• Locations

  • How to create and modify them

  • How to designate a location manager

  • Open

    

• 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 https://medtrainer.atlassian.net/wiki/spaces/CSKB/pages/4159505060 SOP for more information.

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.

Practice Locations

The first step is to create the practice locations. As a recommendation, if the needed locations are less than 10, it is faster to individually create them. If there are several locations, it is faster to download our CSV template, populate the information, and then upload the file so they can be created in bulk.

Credentialing Information. This is where the admin will be able to set up their practice location details.

Please give the admin a walkthrough of the tabs:

Information

Populating the modules of the Information tab will be helpful not only for better organization, but for a more complete location profile at the time of starting enrollments with payors:

Set Up Insurances

Payors/Insurances that pertain to each practice location can be set here:

Providers

Once providers start getting enabled in each location, and get their provider profiles active, they will start showing below as such:

Verifications

Set verifications for any applicable documents, such as the DEA License Verification.

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:

1. Practitioner License(s)

2. Malpractice Insurance (Certificate of Insurance)

3. DEA (federal) and state CDS certificates

4. Board Certification(s)

5. Diploma – copy of highest level of education (required for non-MD’s,DO’s)

6. Current CV (showing current employer, and all entries have mm/yy format)

7. IRS Form W-9

8. Current driver’s license

Other documents that may be applicable:

1. ECFMG Certificate (if educated outside of The United States)

2. Passport or other citizenship documents (if born outside U.S. and not previously enrolled in Medicare)

3. Collaborative Agreement (required for Nurse Practitioners)

4. Admitting Arrangement letter (required for providers who do not have hospital admitting privileges)

5. 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:

Location Documents

“Documents needed for your legal entity:

1. IRS form CP575 or replacement letter 147C (verification of EIN)

2. CLIA Certificate

3. Business License

4. Copy of office lease (required for therapy facilities)

5. 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:

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

There are two types of NPIs: Type 1, for individual health care providers, such as dentists and hygienists, and Type 2 for incorporated businesses, such as group practices and clinics. In this submodule, the admin will be able to add their organizational NPIs (Type 2) and link them to the corresponding practice locations. 

Departments

Guide the admin through the process of setting up their necessary departments and positions. 

Positions

Remember that we have two databases: the initial 10-page database , and a hidden generic database after clicking on the “Create Position” button. Once the pop-up window shows, there are 3 options:

1. Searching through the Generic Database, selecting and hitting “Create”

2. If they need something more specific (if there are any internal ways of classifying positions), they can click on “Create New”  and type in the position.

3. If they have a similar case as #2, but they need to do a massive position upload, they can click on Upload CSV and upload the filled-in spreadsheet.

Divisions

If  the organization has divisions, these can be added here:

PART 2: The MT Credentialing Module

Visiting Individual Provider Profiles

Activating and Disabling Providers

In the Provider Profiles dashboard, the admin will be able to enable and disable provider profiles, as well as see any terminated provider profiles. Ideally, you should already have at least one active provider profile, which will be used for the walkthrough. 

Practice Locations

Admins can add or remove locations as applicable. If the provider has one main practice location, the system will recognize it as such by having it dragged to the top of the list.

Admins can also pull practice location reports per provider:

Documents

This tab will help the admins monitor provider documents individually. Please provide the steps on:

• Filtering the document list view

• Uploading a new document

• Reviewing the action buttons

• Sending requests

• Reviewing reminders

• Exporting reports

Overview and Filters

Document Requests

Creating Document Containers

Document Action Buttons

Add file version

View detail

Delete document container

Activity logs

Cancel request

Exporting Reports

Switching Profiles

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/

The exclusions tab runs these automatically, so if there are any exclusions involving the provider, they will pop up here:

Verifications

Information

This is where all provider background history is added. Think of this as a very detailed resume. Guide the admins through all the categories, and remember to mention:

• The progress bar will adjust to the amount of information completed.

• All fields highlighted in red are mandatory

• Billing type is pre-set and should remain as is, for this is configured according to initial account set-up found in the https://medtrainer.atlassian.net/wiki/spaces/CSKB/pages/4131422209SOP

Enrollments

“Provider enrollment is the process of registering with an insurance network 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/

This tab is designed to be complex, as there are many factors to consider during the Enrollment process.

Walk the admin through the following steps:

When viewing the Enrollment Details, you will have these tabs available:

• 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 Line of Business

• Process Checklist - The enrollment process to-do list. These lists can be set by provider or group enrollments.

• Notes - Important mentions and updates about the enrollment process.

• Tasks - Here is where items from the process checklist can be assigned to individuals

• Amend Form - Here is where admins can fill in provider initial application forms for any payers they have selected. Each payer has its own fillable form.

• Enrollment Documents - Any documents relevant to the provider’s/group’s enrollment process

• Contacts - Any applicable contact points discovered or needed throughout the enrollment process

• Fax - If any fax messages are received, they will appear here.

• Activity Logs - All in-system actions taken or changes made throughout the enrollment process will reflect here.

Dashboard

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.

Company Settings Part 1

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

Admins can active providers directly from their dashboard, they will be redirected to the provider profiles dashboard.

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

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.

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:

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.

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.

• The View button leads to the Information section of the Enrollments tab of the corresponding provider profile.

• The New Enrollments button leads to creating any missing enrollment application records for providers

Credentialing Dashboards

This dashboard provides a summary on the following regarding enrollment applications:

• Open and Closed Enrollment Applications

• Top 5 Most Open and Closed Enrollment Applications

• Open and Closed Applications Age

• Top 5 Oldest and Slowest Cases

The goal is to give the admin full visibility of what is happening, as well as notice trends and outliers.

Insurances

This module simply summarizes the list of Insurances linked to the account’s Practice Locations:

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 Types of Business Entities - NerdWallet

This dashboard will let admins and super admins manage and create new business entities:

Locations

Though we mentioned this module in part 1, admins are able to do much more:

• Viewing location details here

• Filtering locations (by credentialing enabled/not enabled, and more)

• Create new locations

• Multiple setup:

  • Adding multiple verifications

  • Adding multiple documents

  • Enabling insurances in multiple locations

Credentialing (In-App) Reports

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.

Settings

Simple changes like enabling email notifications, changing the company name and address, and updating the super admin’s password.

Company Settings

These help our admins tailor out how they want their LMS accounts to work. Remember to go into module-specific settings here:

• Under General Settings:

  • Provider number

• Under Reminders:

  • Enable Provider Notifications (Credentialing)

• The Credentialing Tab

PART 3: The Exclusions Module

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:

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:

Current Employee Settings

Admins will be able to configure specific exclusions per provider here:

Notifications

This  submodule will simply help configure enrollment notifications:

Exclusions (In-App) Reports

We will be retracing the steps on Credentialing (In-App) Reports section.

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

• http://Support.medtrainer.com

• 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:

• https://medtrainer.atlassian.net/wiki/spaces/CSKB/pages/4221468673

• https://medtrainer.atlassian.net/wiki/spaces/CSKB/pages/4221436306

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.