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 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 Credentialing Requirement
Add Credentialing Requirement to the Insurance
In the Insurance Libraries, select the Insurance.
Select the checkbox for Credentialing Required.
Select Save (F2).
Add Credentialing Effective Date
The Credentialing Effective Date must be added on the Insurance Dashboard or the Provider Dashboard.
On the Insurance Dashboard, select Provider Credentials or on the Provider Dashboard select Credentialing.
Select the Edit icon
on the Provider to add the Effective Date or on the Provider Dashboard, choose the Insurance.
Enter the Effective Date.
Update associated claims to Ready for Submission: Select the checkbox for any existing claims to be auto-released for batching.
Select Save (F2).
Modify Multiple Providers' Effective Credentialing fields on the Insurance Dashboard
Select the Provider Credentialing link on the Insurance Dashboard.
Choose the checkboxes for the providers where the change should be made.
Select the Modify Selected Providers button.
Make changes to the editable fields.
Remove Credentialing: Credentialing can be removed from one or multiple providers.
The Effective Date can be changed.
Update associated claims to Ready for Submission: 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
Change the Effective Date for multiple Insurances in one step on the Provider Dashboard.
Select the Credentialing link on the Provider Dashboard.
Choose the checkboxes on the Insurances where the Effective Date should be added.
Select the Modify Selected Insurances button.
Modify Editable fields.
Select the Modify Selected Providers button.
Enter the Effective Date.
Update associated claims to Ready for Submission: Select the checkbox if you want any existing claims to be auto-released for batching.
Select Save (F2).
Remove Credentialing
In the Credentialing panel on the Provider Dashboard, choose the Edit icon
on the Provider.
Select the checkbox for Remove Credentialing.
Select Save (F2).
Claims Submission Queue to Modify a Provider's Credentialing Fields
Use the Claims Submission Queue to modify a Provider's Credentialing fields.
In the Claims Submission Queue panel on the Claims Management screen, select the number link in the Encounters column.
Select the Insurance link.
Remove the Provider ID from the Filter Criteria.
To edit one Provider, select the Edit icon
for the provider.
On the Modify Provider screen, modify editable fields:
the Effective Date,
check/uncheck Release all Credentialing Claims, or Remove Credentialing.
Select Save (F2).
Claims Submission Queue to Modify Multiple Providers' Credentialing Fields
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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