What's on it
Gather the documents first. Most delays come from a missing certificate or an out-of-date CAQH profile.
Documents to gather
- State RN and APRN or CRNA licences
- NBCRNA certification
- DEA registration and any state controlled substance licence
- Malpractice certificate of insurance
- CV with no unexplained gaps
- Diplomas and education history
- Government ID and Social Security number (stored securely)
Identifiers and profiles
- Individual NPI confirmed with the right taxonomy
- CAQH profile complete, attested and shared with payers
- PECOS account for Medicare enrollment
Medicare
- Individual enrollment submitted
- Reassignment of benefits to the group submitted
- Effective date confirmed before billing
Medicaid and commercial
- State Medicaid enrollment
- Each Medicaid managed care plan
- Each commercial payer the facilities' patients use
- Approval letters and effective dates saved
Facility privileges
- Privileges or credentialing at every facility
- Facility-specific requirements done (training, health records)
Keep it current
- Licence and certification expiry dates on a calendar
- Medicare revalidation date tracked
- CAQH re-attested on schedule