Credentialing SOP
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      Credentialing Status Report Job Aid

      This Job Aid provides information on how to properly document notes in Modio-OneView Credentialing software for valid Credentialing Provider’s Status report.

      This will also provide information on how to send these reports for providers/ practices from Hubspot for tracking/ documentation. 

      2   Overview:

      While statusing payers in OneView (Modio), be sure to update all notes in the payer, Team Notes section as well as the step that you are working in Tracking for that particular payer. Set appropriate follow up dates and status for payer while doing this.

      ALL payer lists in OneView/ Modio MUST be CAQH for all credentialing clients unless only working on state or government payers. 

      NOTE: If something is needed from the CAM, Set status of payer to most applicable per above AND do the following:

      1. If in an open step in tracking be sure not notate that step, update status if needed and set new follow up (end) date AND Assign to the CAM as assignee who will own that step until reassigned.

      2. Copy note to “Team” note section for payer.

      3. Create a task and assign task to the CAM . In these tasks you can put detailed notes, attach documents. etc. This info does not carry over to the payer or provider profile so please notate both.

      When setting end dates, please do not set them for more than 7 days out.

      NOTE: If follow up/end date falls on a Holiday use the day after or day before as the date for follow-up.

       If there is anything URGENT required from the CAM/Payer please follow above steps and chat or ping CAM in Microsoft Teams. **CAM should act as soon as possible & if any notification to customer is warranted this should be handled as priority**

      Status reports will be sent once per month, the CSR should have it ready by the first Wednesday of every month for review by the CAM. CAM is required to send via Hubspot email to the practice/ provider no later than the first Friday of every month.

       

      MAINTENANCE/ RETAINER clients require regular monthly attention. We must ensure there are no gaps in attestation, expired documents, contract revalidation, etc. 

      3 Process

      Download the Report

       To export the report go to Modio and click on Team and from the “Alerts” drop down select “Monthly Status Report”

       The CSV will download to your computer. Open report and sort as follows:

      1. click the upper left corner between A and 1 to select the entire sheet.

      2. click on “Data” in the toolbar and then “Sort”

      3. in the first “sort by” box select “Practice/Affiliation”

      4. Click +Add Level and select “Last Name” (which is the provider last name)

      Save as Excel.

      Review and validate data. Remove data that does not belong to the provider/ practice you are sending to.

      In the event there are multiple providers and / or the group that you must report status on, you can cut and paste separate providers on each sheet of the excel workbook. 1 provider per sheet or tab in excel worksheet. Remember to password protect every sheet.

      Save a copy of the report on your PC. Lock the sheets by right clicking on the Sheet and click on “Protect Sheet.” Use the generic password HPI123

      Once you have a report drafted and you feel its ready for CAM review please send directly to the CAM via email and CC your manager. Once the CAM has reviewed and approves to share the status report with the provider/ practice move to step 4.

      4      Send report via e-mail

       

       The report must be sent via HubSpot, to send emails follow these steps:

      a.       Go to Contacts > Companies and search for the account. Ensure you have the Parent account not the child account.

      b.      Click on tickets and “view all +in filtered view” then select “Credentialing Status” pipeline and locate the Credentialing Status ticket that is open for the account you are working. You will send the email from this ticket.

      c.   To send the email go to Emails and click on Create Email

      d.       Choose a recipient from Contacts associated with your ticket.

      ALL Status report email sent monthly MUST include the billing operations consultant as a CC.

      e.       Search and select the Template Credentialing Status Update (Monthly), upload the status report as an attachment and click Send

      Be sure that before sending the email, you attach the report to your email (this will automatically add the document to HubSpot Attachments for the company you are in)

      5 Credentialing Complete

      Once all credentialing is completed or the client has cancelled RCM Service and we are closing the credentialing out for a client you must notify the customer with an email and a final status report sent from Hubspot. Use the template titled “Credentialing is Complete”.

      1. From your credentialing status ticket, click create email and select your primary contact . Remember to include CC for Operations Consultant and your credentialing manager so they are aware your credentialing has been completed

      2. Click on templates and find “credentialing is complete”

      3. This will populate the email body and subject for you.

        1. Add attachment of final status report

        2. Send

      Next you will need to update your ticket in order for it to be marked complete.

      1. Under “Credentialing Status” change the payer status to completed

      2. add a date to “credentialing completed date”

      3. This will automatically move your ticket to Completed status.

      6 Enrollment Submission

      Don't forget to submit any necessary enrollment tickets to get connections for EDI, ERA and / or EFT set up for the account. See Enrollment Inquiries & Requests

      Note: If there are any missing documents from your enrollment submission ticket, enrollments will reach out to you. All other communications will be done between enrollments and the operations consultant.