Hold Billing for Provider Credentialing
Insurances can be flagged to require Provider Credentialing.
- The corresponding System delivered Charge Management Rule will create a Validation Warning when saving the Claims.
Claims are Flagged in the Claims Submission Queue
The Claims will be flagged in the Claims Submission Queue as Credentialing Required.
Even though the claims are "technically" Ready for Submission, they will not batch for submission.
The claims will be auto-released when a valid credentialing effective date is reached.
Set up the Credentialing Requirement
- From Libraries on the Left Side Menu, select the Insurances button.
Select the Insurance ID link.
Select the Modify link.
On the Select the checkbox for Credentialing Required.
Select Save (F2).
Add the Credentialing Effective Date
The Credentialing Effective Date must be added on the Insurance Dashboard or the Provider Dashboard.
In the Provider Credentials panel on the Insurance Dashboard, select the Modify icon on the Provider where the Effective Date is to be added.
Enter the Effective Date.
Release all Credentialing Claims: Select the checkbox for any existing claims to be auto-released for batching when the credentialing is accomplished.
Select Save [F2].
The Effective Date can also be added on the Provider in the Billing/Rendering Provider Library.
In the Credentials panel, select the Modify icon on the appropriate Insurance.
Enter the Effective Date
Release all Credentialing Claims: Select the checkbox for any existing claims to be auto-released for batching when the credentialing is accomplished.
Select Save [F2].
Modify Providers Credentialing Information
Select the Provider Credentialing link on the Insurance Dashboard.
Select the checkboxes for the providers where the change should be made.
Select the Modify Selected Providers button.
Make the modifications.
Remove Credentialing: Credentialing can be removed from one or multiple providers.
The Effective Date can be changed.
Release all Credentialing Claims: Select the checkbox if you want any existing claims to be auto-released for batching.
Select Save (F2).
Change the Effective Date for multiple Insurances in one step on the Provider Dashboard.
Select the Credentialing link on the Provider Dashboard.
Select the checkboxes on the Insurances where the Effective Date should be added.
Select the Modify Selected Insurances button.
Modify the fields.
Remove Credentialing: Credentialing can be removed from one or multiple providers.
The Effective Date can be changed.
Release all Credentialing Claims: Select the checkbox if you want any existing claims to be auto-released for batching.
Select Save (F2).
Use the Claims Submission Queue to modify multiple Providers' Credentialing Fields in one step.
On the Claims Submission Queue, select the number link in the Encounters column.
Select the link in the Insurance column.
Remove the Provider ID from the Filter Criteria.
Select Search.
Select the checkboxes for the Providers’ credentialing where the Effective date or Release all Credentialing Claims needs modification for this Insurance.
Select the Modify Selected Providers button.
Make changes to the editable fields.
Select Save (F2).
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Remove "Credentialing Required"
In the Credentialing panel on the Provider Dashboard, Select the Credentialing link.
Select the checkbox for Remove Credentialing from specific Insurances.
Select Save (F2).
Select the Remove Credentialing checkbox.
Select Save [F2].