Credentialing Roster

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. Filter by — At the top of the page, use one or more filter fields to narrow the search for providers.
• Provider — Select a provider from the list.
• Scheduling name — Select a scheduling name from the list.
• Medical group — Select a medical group from the list.
• Provider group — Select a provider group from the list.
  Note: This option appears only if you use provider groups.
  
3. Click Filter.
   The filtered list of providers appears on all tabs.
   
4. To create an Excel report, click Filter and Download.
   The search results appear on your screen and in a report.

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. Click the Not on Credentialing tab.
3. Locate the provider in the Provider Name column and click add next to her name.
4. If you are accessing this provider record for the first time, the Provider NPI Match window appears, where you enter initial information for the provider.
   
1. First name — Enter the provider's first name.
2. Last name — Enter the provider's last name.
3. NPI — Enter the provider's NPI number. If you don't know the provider's NPI number, click lookup to search the National Plan and Provider Enumeration System (NPPES) for NPIs that match the provider's first and last name. If you can't find the provider's NPI, you can select the I don't have this information right now option.
4. Click Continue.

Enter demographic and practice information

5. Practice start date — Enter the date you expect the provider to start providing services.
6. DOB — Enter the provider's date of birth.
7. CAQH # — Enter the provider's Council for Affordable Quality Healthcare (CAQH) Universal Provider Datasource (UPD) number.
8. CAQH username — Enter the provider's CAQH UPD username.
9. CAQH password — Enter the provider's CAQH UPD password. This password is stored securely so that athenahealth can update the UPD profile on the provider's behalf.
10. Primary service location — Select the primary department where the provider will provide services.
11. Other locations — Click Selected and then select any other departments where the provider will provide services.
12. Practice contact — Select the practice credentialing manager who will be the primary contact during the credentialing process for this provider.
13. Email — Enter the provider's email address.
14. Phone Number — Enter the provider's phone number.
• Specify whether this phone number is a home, cell, or work number.
• To add another phone number, click the plus icon.
15. Click Next.
16. Payers — If you see a list of payers, each payer can be set as follows:
• Default — The payer with which you will credential the provider.
  Note: In general, leave the Payers field set to Default.
• Non-par — Select non-par to indicate that this provider will be billed as out of network with this payer.
• Not Billing — The practice will not bill the payer for the provider's services.
17. Click Next.
18. Based on our knowledge of payer document requirements, the documents that we'll need during the credentialing process are listed. If these documents are available, upload them.
19. Click Next.
    
20. Review the credentialing information for the provider and click Approve. If the information is incorrect, click Back to edit information on a previous tab.

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. Click a provider name in the On Credentialing tab.
   Another row appears below the provider name row.
3. Click terminate in the Action column.
4. Termination date — Enter the date when the provider will no longer be working at your practice.
5. Click Save.

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. Click a provider name in the On Credentialing tab.
   Another row appears below the provider name row.
3. Click edit in the Service Locations column.
4. Service locations — Select or deselect departments for this provider.
5. Primary service location — If necessary, select a primary service location for this provider.
6. Click Save.

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. Click a provider name in the On Credentialing tab.
   Another row appears below the provider name row. Any credentialing applications in process by your practice appear in the Your Application Tasks column.
3. Click update in the Your Application Tasks column, then do the following, depending on the type of task:
• Mark as received — Select this option to confirm that you received information from the payer showing that the application is complete.
• Legacy number — Enter a payer-specific legacy number, if issued.
• Effective date — Enter the effective date for credentialing, if issued. Claims are held prior to the provider's effective date.
• Welcome letter — Click Choose File, locate the .pdf document to upload, and select it. The .pdf file is attached to the provider's application record.

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. In the On Credentialing tab, locate the provider name.
3. Click go to profile in the Action column.
   The provider profile appears.
   

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. In the On Credentialing tab, locate the provider name.
3. Click go to profile in the Action column.
   The provider profile appears.
4. Click the Documents tab.
   Each document is listed with additional information, such as document status.
5. On the Documents tab, you can click upload or delete next to the document name.

Note: You can also upload credentialing documents from the Credentialing Worklist or the Enrollment Worklist page.

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. In the On Credentialing tab, locate the provider name.
3. Click go to profile in the Action column.
   The provider profile appears.
4. Click the Documents tab.
   
5. Click add provider document.
   Additional fields appear.
   
6. Document — Click Choose File, locate the .pdf document to upload, and select it.
7. Provider — This field contains the name of the provider. You do not need to edit it.
   
8. Document Type — Select the document type.
9. Classification — Enter any classification information, if needed.
10. Effective Date — Enter or select the effective date of the document, if applicable.
11. Expiration Date — Enter or select the expiration date of the document, if applicable.
    Note: Depending on the document type that you selected, you may need to enter information in additional fields that appear (e.g., the State field if you selected State License Certificate as the document type).
    
12. Click Add.
    A link to the document appears on the Documents tab of the Provider Summary.

Group documents apply to the whole medical group, such as insurance rosters.

Note: You can also perform this task on the Enrollment Worklist page.

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. In the On Credentialing tab, locate the provider name.
3. Click go to profile in the Action column.
   The provider profile appears.
4. Click the Documents tab.
   
5. Click add group document.
   
6. Document — Click Choose File, locate the .pdf document to upload, and select it.
7. Medical Group — Select the medical group to which the document applies.
   
8. Departments — Select Applies to all Departments or Only applies to some Departments. If you select Only applies to some Departments, select the departments from the list.
9. Document Type — Select the document type.
10. Classification — Enter any classification information, if needed.
11. Effective Date — Enter or select the effective date of the document, if applicable.
12. Expiration Date — Enter or select the expiration date of the document, if applicable.
    Note: Depending on the document type that you selected, you may need to enter information in additional fields that appear (e.g., the State field if you selected State License Certificate as the document type).
    
13. Click Add.

1. Display the Credentialing Roster page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Roster.
2. In the On Credentialing tab, locate the provider name.
3. Click go to profile in the Action column.
   The provider profile appears.
4. Click the Profile tab.
   The profile has four main sections:
   • Provider Demographics — Includes basic demographic information, addresses, the provider's athenahealth provider record, and practice information. In the Practice Information section, note the following fields:
     • Primary service location — The primary location at which the provider works and bills claims.
     • Practice start date — The date on which the provider starts work at the practice.
     • Practice termination date — The date on which the provider ends works at the practice, if known.
     • Terminated? — Whether the provider no longer works at the practice.
     • On credentialing? — Enables the Credentialing Service for the provider.
   • Medical & Practice Info — Includes sections for provider numbers (that is, NPI and UPIN), specialty, licenses, DEA registration, state-controlled substance certificates, life-support certification, and hospital affiliations. You can upload supporting .PDF documents in these sections.
   • Education & Training — Includes sections for pre-professional school (undergraduate) and professional school (e.g., medical school, nursing school).
   • Reference & Legal — Includes sections for work history, references, insurance, and a standard set of disclosure questions.
5. To edit the information in a section:
   1. Click Edit in the upper right corner of the section.
      
   2. Edit the information as necessary.
      
6. To save the information in a section, click Save. Alternatively, click Save & Next to save the information and immediately open the next section for editing.
   

A credentialing application can have any of the following statuses:

• Awaiting Documentation — Pending receipt of welcome packet from the provider.
• Generate Form — The practice can generate credentialing applications for the provider.
• With Payer — The credentialing application has been submitted to the payer.
• Pending Prerequisites — A payer task is pending for missing documentation, CAQH attestation, or another application to be completed before submitting a credentialing application.
• Escalate Client — Documents are required by a payer or are set up as Practice Required documents and require attention from the practice's credentialing manager.
• Complete — Your practice has received confirmation from the payer that the application is complete.
• Uploaded — The document has been uploaded but has not yet been updated to On File status.

A provider or medical group (in instances where your practice bills as a group) can have any of the following credentialing statuses with a payer:

• Participating — The provider is contracted with the payer or belongs to a group that is contracted with the payer.
• Not Participating — The provider is contracted with the payer, but at lower, out-of-network rates than providers with the credentialing status of "Participating."
• In Progress — Hold Claims — The provider is in the process of credentialing with the payer. Hold claims until a specified date.
• In Progress — Send Claims Non-Par — The provider is in the process of credentialing with the payer. Send claims as Not Participating (non-par) until a specified date.
• Credentialing Overdue — athenaOne assigns this status automatically when the expected completion date (ECD) has passed for a provider that was originally in one of these statuses: "In Progress — Hold Claims" or "In Progress— Send Claims Non-Par."
• Not Billing — The provider is not contracted with the payer and does not bill the payer.
• No Credentialing Info — The payer was recently added but the provider's credentialing status with the payer has not yet been entered.

A credentialing document can have any of the following statuses:

• Escalate Client — This document is required for review.
• Expired — The document has passed its expiration date. The provider needs to upload a non-expired version of the document.
• Expiring — The document is within 60 days of expiration. The provider needs to upload a non-expired version of the document soon.
• Not On File — The provider needs to upload the document for credentialing.
• Not Required — The provider does not need to upload the document for credentialing.
• On File — The document has been uploaded and verified by Credentialing Services.
• Uploaded — This document will be set to On File by athenahealth. No verification of the document will be completed.