Provider enrollment is not managed through one application or portal. Successful onboarding and continued participation require healthcare organizations to coordinate information across CAQH, PECOS, NPPES, CMS Identity & Access Management, payer-specific applications, and internal credentialing systems.

Each platform serves a different purpose. NPPES establishes and maintains National Provider Identifier information. I&A controls access and organizational relationships within CMS enrollment systems. PECOS manages Medicare provider and supplier enrollment. CAQH allows providers to maintain and share professional, credentialing, practice, and directory information with authorized organizations.

When these systems are handled separately, conflicting data, incorrect access roles, incomplete documentation, missed attestations, and delayed revalidations can prevent providers from being enrolled or reimbursed on time.

This practical webinar will explain how the four systems work together and how healthcare organizations can build an organized enrollment process for individual providers, groups, locations, reassignments, changes of information, ownership changes, and revalidation.

Participants will also learn how to establish appropriate user access, organize supporting documentation, monitor application status, maintain CAQH profiles, and reduce delays caused by incomplete or inconsistent information.

Why This Webinar Matters Now:

• The redesigned PECOS application and national-profile workflow
• Medicare revalidation deadlines
• NPI and practice-information accuracy
• I&A access and organizational connections
• CAQH attestations and expiring documents
• New providers, locations, groups, and ownership information
• Reassignments and termination of billing relationships
• Payer-specific follow-up and effective-date confirmation

An incorrect record in one system may not automatically update the others. Enrollment teams therefore need a clear process for determining where information belongs, who is authorized to update it, what documentation is required, and how each submission will be monitored.

Learning Outcomes:

• Explain the purpose of CAQH, PECOS, NPPES, and I&A
• Understand how the four systems support credentialing and payer enrollment
• Establish individual and organizational records using the correct sequence
• Assign and manage appropriate CMS access roles
• Navigate the current PECOS application and national-profile workflow
• Prepare information and supporting documents before beginning an application
• Manage Medicare initial enrollments, reassignments, changes, and revalidations
• Maintain accurate and complete CAQH provider profiles
• Use Practice Manager functionality for multiple providers
• Identify inconsistencies that may delay payer processing
• Develop an organized provider-enrollment intake and tracking process
• Improve communication among providers, credentialing, enrollment, billing, and revenue-cycle teams

Areas Covered in the Session:

• The roles of CAQH, PECOS, NPPES, and I&A
• How the four platforms interact—and where they do not
• Creating and maintaining individual and organizational records
• NPI information and NPPES updates
• I&A employer connections and access roles
• Authorized Officials, Delegated Officials, Access Managers, staff users, and surrogates
• PECOS national profiles and pre-populated applications
• Individual, group, and organizational Medicare enrollments
• Provider reassignments and group relationships
• Participating-provider status and special-payment addresses
• Practice locations and organizational information
• Supporting-document preparation and upload
• Electronic signatures and application submission
• Real-time application tracking and MAC follow-up
• Medicare revalidation due dates and monitoring
• Changes of information and changes of ownership
• Provider onboarding and offboarding
• CAQH registration, profile completion, authorization, and attestation
• Required CAQH information and supporting documents
• Expiring documents and recurring profile maintenance
• Practice Manager workflows for multiple providers
• Payer-specific follow-up after CAQH completion
• Telemedicine enrollment considerations
• Internal tracking, quality control, and escalation
• Live question-and-answer session

This webinar is recommended for:

• Provider Enrollment Directors, Managers, and Specialists
• Credentialing Directors, Managers, Coordinators, and Specialists
• Medical Staff Services Professionals
• Certified Provider Credentialing Specialists
• Certified Professional Medical Services Management Professionals
• Revenue Cycle Directors and Managers
• Managed Care Enrollment Teams
• Healthcare Administrators
• Practice Administrators and Practice Managers
• Clinic and Office Managers
• Provider Data and Directory Teams
• CAQH Support Staff
• NPPES and I&A Support Staff
• Billing Companies
• Healthcare Billing Professionals
• Operations Leaders
• Compliance Professionals
• Allied Health and Advanced Practice Providers
• Clinical Directors
• Practice Owners
• Healthcare Consultants