Revenue Cycle Insider

Question: How do I avoid enrollment and recredentialing delays when provider information must be maintained across multiple systems? Our practice updates DataSpring, powered by CAQH, as well as NPPES, PECOS, payer portals, and internal records. I’m concerned that a change entered in one system may not appear in the others.

Iowa Subscriber

Answer: Start by establishing and using one controlled workflow for all provider-data changes. To cover all of your bases, assign one person to be in charge of credentialing coordination and see each change through confirmation. Consider tracking these submissions in a centralized enrollment matrix that lists each provider, location, payer, portal, submission requirement, recredentialing or revalidation date, responsible staff member, status, confirmation number, and follow-up deadline. Enter addresses, tax data, and effective dates consistently, and set alerts before credentials expire.

DataSpring states that its Provider Data Portal — the platform formerly associated with the Council for Affordable Quality Healthcare (CAQH) name — reduces duplicative data collection and allows authorized organizations to access provider information. However, updating DataSpring does not automatically update the National Provider and Plan Enumeration System (NPPES); Provider Enrollment, Chain, and Ownership System (PECOS); commercial payer systems; or the practice’s internal records.

Consider using a template or other standardized form to capture the provider’s legal name, individual and organizational national provider identifier (NPI), taxonomy, licenses, Drug Enforcement Administration (DEA) registration (if applicable), practice and mailing addresses, effective date, tax identification number, reassignment relationships, liability coverage, and supporting documents. Identify every affected system and create a submission checklist.

Maintaining consistent information across NPPES, PECOS, payer portals, and internal systems can help reduce enrollment, credentialing, and claims-processing delays. The Centers for Medicare & Medicaid Services (CMS) says providers and suppliers remain responsible for tracking Medicare revalidation dates, and it posts due dates through its Medicare Revalidation List. Practices should regularly monitor Medicare revalidation requirements and related CMS resources.

The person who’s designated as the credentialing update coordinator should not close a task until each organization confirms its record was updated. They should save correspondence and confirmation numbers, monitor requests for additional information, and reconcile approved data across DataSpring, NPPES, PECOS, payer portals, the practice management system, claims settings, and directories. Prioritize resolving any discrepancies before billing from a new location or under a new arrangement.

Some additional best practice tips:

• Use role-based access, not shared credentials, and train a backup staff member to monitor pending work.
• Run a monthly exception report for approaching expirations, overdue attestations, unanswered payer requests, pending applications, and inconsistent data.
• Before recredentialing or Medicare revalidation, reconcile all systems and correct discrepancies. CMS cautions that missing a revalidation deadline may result in a payment hold or deactivation of Medicare billing privileges, with no Medicare payment for services furnished during the deactivated period.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC