Medical Group Credentialing

On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Medical Group Credentialing

1. Display the Medical Group Credentialing page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Credentialing, click Medical Group Credentialing.

To filter the Update Credentialing Statuses list

2. Task status — Select the tasks that you want to update.
   • Show Only Open Tasks — Display all credentialing tasks whose status is blank or Credentialing — Overdue.
   • Show Credentialing Tasks — Display all credentialing tasks whose status is Credentialing — Overdue, In Progress — Send Claims Non-Par, or In Progress — Hold Claims.
   • Show All Tasks — Display all credentialing tasks, regardless of status.
3. Select a medical group or enrollment category to display tasks for the selected medical group or enrollment category only.
• Medical group — Select a medical group from the menu.
• Enrollment category — Select an enrollment category from the menu.
4. Click Filter.
   The Update Credentialing Statuses section shows the filtered results.

To apply changes to all rows in the table

5. Also apply changes to open tasks for the following groups — If you filtered the list by medical group, you can apply the same credentialing status to other medical groups selected from the list (use the Ctrl key to select more than one medical group).
6. Also apply changes to the open tasks for following Enrollment Categories — If you filtered the list by enrollment category, you can apply the same credentialing status to other enrollment categories selected from the list (use the Ctrl key to select more than one category).
7. Set all rows on page to this status — To set all the rows in the table to the same credentialing status, select that status from the menu and click Set.
   Note: If you select the status In Progress — Hold Claims or In Progress — Send Claims Non-Par, the Date Application Submitted field appears. Enter the submission date in this field and then click Set.
8. Click Save at the bottom of the page.

To apply changes to individual rows in the table

9. Credentialing Status — For each row that you want to update, click the menu in the Credentialing Status column and select the credentialing status.
10. Application Submission Date — If you select the status In Progress — Hold Claims or In Progress — Send Claims Non-Par, this field appears. Enter the date that you submitted the credentialing application to the payer.
    The Estimated Completion Date field appears with the athenahealth estimated completion date.
11. If you know that the payer plans to process the application before or after the Estimated completion date, click Edit and enter a different date in the field.
12. Click Save at the bottom of the page.

A credentialing status indicates the contractual relationship with a payer; this contractual relationship can apply to a provider or a medical group. The credentialing status determines payer network privileges, reimbursement rates, and enrollment requirements. Credentialing statuses in athenaOne are:

• Participating — The provider is contracted with the payer or is part of 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 contracting with the payer. Hold claims until a specified date.
• In Progress — Send Claims Non-Participating — The provider is in the process of contracting with the payer. Send claims as Not Participating (non-par) until a specified date.