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Solve Payor Credentialing and Enrollment Claim Denials to Get Claim Paid Faster

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All too often a Medical Services Professional (MSP) performs both Credentialing and Payor Enrollment functions in their day to day role; however, our process generally will culminate to the receipt of the “Effective Date Letter.”  However, this is only half the way in Payor Enrollment – The true final step is a successful paid claim for the services rendered by the enrolled provider. Claims are denied for many reasons, but a standard catch all denial reason falls into a Credentialing/ Payor Enrollment bucket usually we see the standard B7 Denial. The provider was not certified/eligible to be paid for this procedure/service on date of service” or “Services not covered by plan.” All of these relate back to the original task at hand we set out to do for the organization. In this session, we will explore and identify common claim denials and entertain some troubleshooting tasks when the EOB is returned to you without the reimbursement check attached.

Learning Objectives:
  • Learn and understand some common Payor enrollment principles
  • Understand the link between Payor Enrollment & Revenue Cycle Teams
  • Understand the “Life of a Claim”
  • Understand common Payor Enrollment Denial Reasons and tips on how to best troubleshoot each denial reason/code
  • How to proactively solve for Payor Enrollment Claim Denials
  • Resubmissions vs Reconsideration of Claims
  • How the bottom line of the organization is impacted by “Credentialing Denials.”
  • Helpful tips on how to work with stakeholders for scrubbing claims before they are submitted.
Areas Covered in the Session:
  • Provider Enrollment Workflow and Process
  • HCFA Claim Forms 1500 & UB-04
  • Claim Denial Reason Codes/Rejection Codes
  • Patient Registration & Customer Service Techniques
  • Resubmissions vs. Reconsiderations
  • Scrubbing Claims & Forensic Analysis of Claims
  • Impact of Revenue to Organization
  • Live Q&A Session
Suggested Attendees:
  • Payor Enrollment Specialists
  • Credentialing Specialists & Coordinators
  • Medical Staff Leadership
  • Revenue Cycle Leadership
  • Managed Care Enrollment Coordinators & Specialists
  • CPCS, CPMSM Certified individuals
  • Credentialing and Enrollment Specialists, Experts & Leaders
  • Healthcare Administrative Teams
  • Practice Managers
  • Healthcare Billing Specialist
  • Staff Providing NPI Support, NPPES  Support
  • Staff Providing CAQH Support
  • Clinic Managers
  • Allied Health Providers
  • Advance Health Practitioner
  • Enrollment
  • Office Managers
  • Operations
  • Coders
  • Clinical Directors
  • Practice Owners
  • Claims Teams
  • MSPs
Presenter Biography:

Larry DeHoyos, CPCS, PESC is a thought leader and innovator with more than 24 years working experience as a Medical Staff Professional. He is nationally certified as a Provider Credentialing Specialist and also holds certificates in Provider Enrollment and as a Transformational Healthcare Champion. His expertise spans all 50 states within a multitude of healthcare spaces including Health Plan, Managed/Specialty Care, Outpatient/Surgical spaces, Laboratories and most recently within a Healthcare Staffing Agency as Director of Credentialing for a per diem staff network of over 32,000 nursing professionals. Larry’s knowledge and experience sets his intent outside of the bounds of the industry and focuses on helping organizations solve challenges in process, technology and compliance within Credentialing, Provider Enrollment, Revenue Cycle and Accreditation Readiness. He is an active member with the National Association of Medical Staff Services and state and local chapters for California, Massachusetts and Texas. He has spoken on various industry topics for platforms as McKnight’s Long Term Care News, NAMSS, National Provider Enrollment Forum, and various State and Local Associations of NAMSS.


This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.


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TESTIMONIALS

“Jim Sheldon-Dean’s insights on privacy and security were very much helpful to our team, it was great to learn from an instructor like him. Appreciate!”–CHRISTINE JACOB MD, CDI SPECIALIST

“This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course.” –MELISSA PRESTON, HEALTH INFORMATION MANAGEMENT STAFF

“The workshop was very insightful and made absolute sense in terms of the regulations and their compliance. I am thankful for having the opportunity to attend.”–BARBARA CAPRIOTTY, REHABILITATION DIRECTOR

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