Managed Care Magic Season 1 On Demand

Description

Completing the Puzzle: Who’s Who in Managed Care Credentialing

It’s crucial to have a solid grasp of the basics before diving into the deeper issues surrounding managed care credentialing. Join Donna Goestenkors, CPMSM®, EMSP, and Ivonne Oladunni, MBA, CPMSM® in exploring the roles and responsibilities of stakeholders in managed care and how the pieces of managed care fit together.

Objectives:
Identify the regulatory and accreditation bodies that oversee managed care
Explain the types of organizations that are accredited by CMS, NCQA, and URAC
Describe which environments perform credentialing under CMS, NCQA, and URAC standards

Building the Guardrails: Managed Care Governance & Policy

Regulators and accrediting bodies are prescriptive about managed care committee responsibilities and governance policy language. Join Rachelle Silva, BS, CPCS®, CPMSM®, and Ivonne Oladunni, MBA, CPMSM® in exploring the necessary governance structure needed to successfully navigate the managed care landscape.

Objectives:
Explain committee structure, responsibilities, and authorizations in the managed care environment
Identify 4 provisions that must be included in managed care governance documents
Describe 5 required managed care procedures for proper documentation and decision making

Verification Station: Managed Care Compliance Across Accreditors

There are subtle and not-so-subtle differences among CMS, NCQA, and URAC verification standards. Join Rachelle Silva, BS, CPCS®, CPMSM®, and Ivonne Oladunni, MBA, CPMSM® to understand the nuances of the information that needs to be verified, acceptable sources outside of the primary source, required documentation, and verification/attestation time frames.

Objectives:
Describe the difference in verification requirements between physicians and APPs
Explain accepted verification sources for each accrediting body
Identify the verification/attestation time frame for each accrediting body

Emerging Issues: Ongoing Monitoring & System Controls

Ongoing monitoring and credentialing system controls are increasingly important in the managed care environment. Join Rachelle Silva, BS, CPCS®, CPMSM®, and Ivonne Oladunni, MBA, CPMSM® in exploring requirements for the frequency of monitoring, acceptable sources, and credentialing system controls monitoring and reporting requirements to ensure the accuracy, completeness, and confidentiality of credentialing information.

Objectives:
Explain the 3 factors for ongoing monitoring compliance
Identify acceptable sources and frequency for ongoing monitoring
Define the 5 factors for credentialing system controls monitoring and reporting

Diving Deep: The Ins & Outs of Delegated Credentialing

Delegated credentialing can feel intimidating to both new and seasoned MSPs in the managed care environment. Join Rachelle Silva, BS, CPCS®, CPMSM®, and Ivonne Oladunni, MBA, CPMSM® in exploring the foundations of the delegated credentialing process, the elements of the delegation agreement, and the requirements for annual delegation oversight.

Objectives:
Explain 3 benefits of delegated credentialing to health plans and provider networks
Identify 6 steps necessary for successful delegated credentialing
Describe the the pre-delegation/annual oversight audit process

January 30, 2024
Acing the Audit: Avoiding Common Deficiencies

Stellar managed care credentialing helps ensure quality care, patient and physician satisfaction, and cost management, but mistakes can happen. Join Rachelle Silva, BS, CPCS®, CPMSM®, and Ivonne Oladunni, MBA, CPMSM® in examining steps to take before, during and after an audit, recognizing the most common deficiencies in the audit process, and identifying corrective actions.

Objectives:
Identify 7 common audit deficiencies
Explain the accepted sources and time frames for appropriate verification/attestation
Describe the appropriate documentation to ensure compliance