2025 CAQH Portal Updates - Credentialing and Reimbursement Simplified
If you want to keep your medical practice’s revenue flowing, your provider’s CAQH profile must be in compliance and up to date. You must accurately implement the mandatory New CAQH changes to get your enrollment approved and payor reimbursement flowing in. This all sounds good, but what does CAQH actually do and how does it reduce this burden? Well, anyone who has done credentialing in any form for a provider knows that the credentialing process is not easy. Each insurance carrier has their own forms and their own process that a provider must follow to join the network for that carrier. During this webinar, participants will learn how to identify and comply with all the implemented CAQH updates to avoid negative revenue impacts; and also know how to reduce payer claims holds and rejections due to inaccurate profile details.
During enrollment and credentialing processes both government and commercial payers use your CAQH profile. Complying with the CAQH changes is also vital to ensure you comply with the No Surprises Act requirements related to current and accurate provider directory listings. Failure to do so can result in heavy penalties violation.
This session will review a step by step each and every section in CAQH. Credentialing and Enrollment specialists are to comply with all the implemented CAQH updates to avoid negative revenue impacts. Implement a solid process for maintaining your CAQH provider accounts and understand how to partner with your practitioners to be fully compliant and structured. Review attestation requirements to speed your re-credentialing turnaround time and create an internal process to easily track CAQH attestations and maintenance.
Learning Objectives
Know how you should implement the new 2025 CAQH updates
Identify if new CAQH Profile/ Module implementation is necessary for your medical practices or not
Pinpoint the data fields & profile sections that will improve your enrollment process
Review the CAQH process connection to the billing claims submission & reimbursements
Know the new rules and guidelines for CAQH
Know how to maintain your CAQH provider accounts compliantly
Review attestation requirements to speed your re-credentialing turnaround time
Review CAQH Groups module
Step by step guide to successfully incorporating this module into your enrollment process
Review CAQH Proview & Groups module
Discuss delegated and non-delegated agreements with payer networks and how that impacts the use of the Groups module for your practice
Guide to successfully incorporating CAQH module into your enrollment process
Areas Covered in the Session
CAQH Provider Data Portal Overview
Step by Step Navigation of CAQH Provider Data Portal
Primary Credentialing Contact
Groups: Delegated and Non-Delegated or Both
Delegated Agreement
Non-Delegated Agreement
Both (Hybrid) - a combination of the above, payer dictated
CAQH Group Process
Maintaining Group Section
Group Details
Legal Business Name
Group Contact
Corporate Address
EIN/TIN - only 1 per group
Group NPI - you can have multiple
Medicaid IDs
Medicare IDs
Assign Providers to the practice locations
Provider Authorization
Provider Status
Our Plans - Delegated only
Our Plans, Add Plans - Delegated only
Plan Authorization
Live Q&A Session
Suggested Attendees
Credentialing Specialist
Enrollment Specialist
Hospitals and Providers
Executive and Administrators
Practice and Clinic Owners
Hospital Leadership
Authorized Officials
Delegated Officials
Revenue Cycle Directors
Office Manager
Revenue Cycle Staff
Operations Staff
Billing Team
In and Out of Network Providers
Medical Billing Companies
Providers Office Staff
Hospitals and Facilities
Mental Health Providers
LCPCs and LMFTs
Insurance Companies
Healthcare Attorneys
Front Desk Staff
Authorizations Staff
Medical Assistants
Certified Nursing Assistants
About the Presenter
Yesenia Servin, CPMSM, PESC, is an expert in credentialing and provider/payer enrollment with over 23 years of experience in the healthcare industry. Yesenia has a deep understanding of Medicare & Medicaid enrollment and is a nationally certified credentialing manager and provider enrollment specialist. Through, YS Credentialing PLLC, Yesenia helps organizations develop and implement best practices guidelines and processes for credentialing and payer enrollment structure. Yesenia manages payer enrollment, keeps team members and colleagues up to date on industry trends, and is a liaison to all departments that impact payer-enrollment processes. Yesenia works with durable medical equipment, hospital and health systems, and community mental health organizations, global managed care organizations as well as providing revenue cycle consulting services to various healthcare providers and organizations.
Yesenia is a current CharterOak University Faculty, NAMSS member, and is a past NAMSS Educational Conference Guest Speaker, a current member of the NAHRI Leadership Council, current trainer for The Chicago School of Professional Psychology trainer and a TMG Collaborator. Yesenia studied microeconomics and communications at NEIU and healthcare administration at Concordia University Chicago.
Additional Information
System Requirement:
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly
Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.
For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com