Provider Credentialing Status Management

To add a provider to a federally qualified health center (FQHC), open a case to enroll the provider in the Uniform Data System (UDS). UDS is a reporting requirement for Health Resources and Service Administration (HRSA) grantees. When you open the case, please specify that you need to enroll a new provider in UDS Quality Management measures for an FQHC practice.

Note: Before providers can be created, the Medical Groups table must be complete.

When you add a new provider to athenaOne, you must enter the provider's credentialing status for each payer that is already set up for your practice. The easiest way to perform this task is from the Providers page.

• When you use the Billing Provider Guided Setup on the Providers page, the Provider Credentialing page appears automatically during the Credentialing step.
• When you configure a provider manually on the Providers page, you can enter the provider's demographic information and then click Save and Update Credentialing. The Provider Credentialing page appears.

On the Provider Credentialing page, you can enter credentialing statuses for the new provider.

Note: On the Providers page, providers without a credentialing status selected appear highlighted in yellow. You can select a credentialing status from the Provider Credentialing 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.

1. Display the Provider Credentialing Status Management page: On the Main Menu, click the Settings icon . Under ADMIN, click Billing. In the Task Bar, under PRACTICE LINKS — Credentialing, click Provider Credentialing.
   
   

2. Click the filter icon next to the column headings and then select filter criteria.
   athenaNet applies the filters.
   

3. Click the X icon or outside the filter window to close it.

Tip: Click Clear all filters to remove any currently set filter options.

You can now see all statuses on the All Statuses tab, including completed ones.

Type or select an option in any of the following fields to filter statuses. Then, click Update or Clear All Refinements.

• Provider Name
• Provider Type
• Medical Group
• Payer

We're increasing your visibility into exactly what you want athenaNet to update on the Provider Credentialing Status Management page.

You must click Review Changes to see a summary of everything you chose to update.

The Provider Credentialing Status Management page displays the "Please Review" table. You can select a different option in the New Credentialing Status and Dates columns, if applicable.

Click Save Changes to confirm your updates.

If you make an update by mistake or if you decide not to save your changes, you can undo all unsaved changes.

Click Undo All Changes to discard your updates.

Read the message in the window and click Ok to proceed. Click Cancel or the X icon to retain current changes.

1. Display the Provider Credentialing Status Management page: On the Main Menu, click the Settings icon . Under ADMIN, click Billing. In the Task Bar, under PRACTICE LINKS — Credentialing, click Provider Credentialing.
   
   

2. You can either:
   1. Remain on the Incomplete Statuses tab to update provider statuses that are incomplete.
   2. Click the All Statuses tab to filter for the providers whose statuses you want to set.
3. Check the box next to the Provider Name column heading to select all providers or check the box next to one or more provider names.
4. Click Copy Statuses From....
   The Copy Credentialing Statuses window opens.
   
5. Select either the Medical Group option (to copy from a medical group) or the Provider option (to copy from a provider).
6. Select a medical group or provider name from the menu.
7. Click Apply.
   
   The credentialing status of either a medical group or provider is applied to the selected provider row(s)

8. Click Review [number] Changes to audit the changes for accuracy.
   
   

   Tip: You can select a different option in the New Credentialing Status column. If the copied over status one of the "In Progress" ones or "Overdue", you can also edit the Dates column.
   
9. Click Save [number] Changes.

1. Display the Provider Credentialing Status Management page: On the Main Menu, click the Settings icon . Under ADMIN, click Billing. In the Task Bar, under PRACTICE LINKS — Credentialing, click Provider Credentialing.
2. You can either:
   1. Remain on the Incomplete Statuses tab to update provider statuses that are incomplete.
   2. Click the All Statuses tab to filter for the providers whose statuses you want to set.
3. Check the box next to one or more provider names or check the box next to Provider Name to select all listed providers.
   
   
4. Click Bulk Edit and select the action:
   • Participating — This provider is contracted with this payer or is part of a group that is contracted with this payer.
   • Not Participating — This provider is not contracted with this payer.
   • In Progress — Hold Claims — This provider is in the process of contracting with this payer. Claims should hold until a specified date.
   • In Progress — Send Claims as Non-Participating — This provider is in the process of contracting with this payer. Claims should submit as Not Participating until a specified date.
     

5. Click Review [number] Changes to audit the changes for accuracy.

   Tip: You can select a different option in the New Credentialing Status column. If the copied over status one of the "In Progress" ones or "Overdue", you can also edit the Dates column.
   
6. Click Save [number] Changes.

1. Display the Provider Credentialing Status Management page: On the Main Menu, click the Settings icon . Under ADMIN, click Billing. In the Task Bar, under PRACTICE LINKS — Credentialing, click Provider Credentialing.
2. You can either:
   1. Remain on the Incomplete Statuses tab to update provider statuses that are incomplete.
   2. Click the All Statuses tab to filter for the providers whose statuses you want to set.
3. Check the box next to one or more provider names or check the box next to Provider Name to select all listed providers.
   
   
4. Click Bulk Edit and select the action:
   • In Progress — Hold Claims — This provider is in the process of contracting with this payer. Claims should hold until a specified date.
   • In Progress — Send Claims as Non-Participating — This provider is in the process of contracting with this payer. Claims should submit as Not Participating until a specified date.
     

5. Select the submission date for the credentialing status — Choose a date from the calendar for the application submission date.

6. Click Set Status.
7. Notice the dates appear filled in for each row you selected.

Notes

• The calendar that appears for date selection defaults to today's date.
• The furthest date you can set is 30 days past today's date, all dates past 31 days are inaccessible.

You can now bulk edit enrollment effective dates on the Provider Credentialing page.

Overview

 

You can now set enrollment effective dates in bulk on the Provider Credentialing page:

• The header of the Application Submission Date column now says Dates
• If the status is set to Participating, you can add Effective date and Expiration date
• Labels appear above the date fields in the Dates column to show the type of date:
  • Effective date
  • Expiration date
  • App submission date
• Once you save your changes the effective and expiration dates are copied to Payer Enrollment page
• If there are already effective and expiration dates, they are overwritten with the new dates
  

Edit enrollment effective and expiration dates in bulk

 

1. On the Provider Credentialing Status Management page, select the rows you need to set effective and expiration dates for.
   

2. Click Bulk Edit.
   

3. Set the credentialing status to Participating.
   A status specific window appears

4. Select a date from the calendar for the Effective date.

5. Select a date from the calendar for the Expiration date.
   

   Note: You can either enter a date manually or choose a date from the calendar that appears when you click the calendar icon. Effective dates must come before the expiration date.
   

6. Notice the dates appear filled in for each row you selected.
   Note:

   • The calendar that appears for date selection defaults to today's date.
   • The furthest date you can set is 30 days past today's date. All dates past 31 days are inaccessible.

1. Display the Provider Credentialing Status Management page: On the Main Menu, click the Settings icon . Under ADMIN, click Billing. In the Task Bar, under PRACTICE LINKS — Credentialing, click Provider Credentialing.
2. Select the tab you want to view:
   • Incomplete Statuses — View the providers with blank, In Progress — Hold Claims, and Credentialing - Overdue statuses.
   • All Statuses — View all statuses, including completed ones.