User Guide — Credentialing Service

The Credentialing Worklist allows you to view credentialing tasks and documents that require attention from your practice and/or providers.

Note: The athenahealth Credentialing Service is no longer available for purchase. Only organizations that purchased the Credentialing Service before 2016 can use the service. The Credentialing Service is for Self-Service use only. athenahealth does not assist in the provider credentialing process.

1. Display the Credentialing Worklist page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Worklist.
   
2. Use the filters at the top of the page to display only the tasks that meet specific criteria. For example, you may want to view only the tasks for a specific provider, document type, or medical group.
3. Do one of the following:
   • To view the worklist in athenaOne, click Filter.
   • To view the worklist in athenaOne and download the worklist as a .csv file, click Filter and Download and then open or save the file.
     
   The worklist appears below the filters.
4. In the "Your Tasks" section, you can click View tasks to view application tasks, welcome packet tasks, document tasks, or Web access tasks.
   

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.

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.
   

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 Dashboard page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Credentialing Dashboard.
2. View by — Select the view for the credentialing information.
   • Provider — The report contains one row per provider, and each row contains credentialing information for all affected payers.
   • Payer — The report contains one row per payer, and each row contains credentialing information for all affected providers.
   • Medical Group — The report contains one row per medical group, and each row contains credentialing information for all affected payers.
3. Medical group — If you selected the Provider or Payer view, you must select a Medical group from the list. If you selected the Medical Group view, you can select a specific medical group from the Medical group list (optional).
4. Provider group — If you selected the Provider or Payer view, you can select a Provider group from the list. This field is not available for the Medical Group view.
5. Primary service location — To view information for a specific location, click Selected and then select the locations from the list (optional).
6. Sort by — Sort the report as follows:
   • A/R — Order the information by the dollar amount of credentialing-related accounts receivable.
   • Name — Order the information by name. The name depends on the selected view. For example, if you selected the Provider view, the report is ordered by provider last name.
7. Show — Select the credentialing information to display in the report.
   • All Credentialing — Include all applications that are in process or completed, claims that are holding due to an application in process, and claims that are holding or denied for other credentialing-related reasons.
   • Credentialing in Progress — Include applications that are in open status and claims that are holding due to the credentialing process.
8. Terminated providers — Select this option to include credentialing information for terminated providers in the report.
9. Application status — Select All to include all application statuses in the report, or select one of these application statuses:
   • Pending welcome packet
   • Pending payer
   • Pending practice
   • Pending prerequisites
   • Reworking application
10. Do one of the following:
    • To view the report in athenaOne, click Filter.
    • To download the report as a .csv file, click Download CSV, and then open or save the file.
    • To reset your filter criteria, click the Reset link.

If you selected the option to view the report in athenaOne, the report appears. At the top of the report, you see a summary of the report information. This summary varies depending on the selected report view (Provider, Payer, or Medical Group).

11. Click the arrow next to a provider or payer name to view detailed information. For example, if you click the arrow next to a provider name, you see information about the payers, credentialing status, application type, application status, and days in application status.
12. Click the name of a provider in the report to display complete information about that provider's credentialing status (see Credentialing Roster for information about the tabs displayed for each provider).

Note: The athenahealth Credentialing Service is no longer available for purchase. Only organizations that purchased the Credentialing Service before 2016 can use the service. The Credentialing Service is for Self-Service use only. athenahealth does not assist in the provider credentialing process.

The athenaCollector Credentialing Service provides the platform for initial setup and configuration, as well as ongoing credentialing and maintenance. You can use dashboards and reports to provide continuous visibility and analysis throughout the payer credentialing process.

The athenahealth Credentialing Service includes:

• Provider setup — After you provide a payer list for provider credentialing, athenahealth updates the system so that provider tasks open automatically each time you add a new provider to Credentialing.
• Expiration management — Reminders about credential expirations (board certificates, state license, DEA certificate) are sent to the email address listed in the Work Email field on the provider profile (click go to profile on the Credentialing Roster page). Reminders are set for 60 days, 30 days, and on the expiration date.

The following athenaOne pages can help you manage and monitor the process of credentialing and recredentialing your providers with payers.

Note: You also have access to the Medical Group Credentialing page and the Provider Credentialing page, where you can change a group's or provider's credentialing status, respectively.

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.