Credentialing SOP
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      Onboarding for Credentialing Clients

      This job aid provides the general requirements for an Intake Specialist to successfully onboard credentialing clients and to conduct a Credentialing Welcome Call.

      There are 3 types of credentialing clients you may need to onboard.

      1. Ala Carte

      2. Smart Start

      3. Retainer/ Maintenance clients

      Process:

      Step 1:  Credentialing – Welcome Call

      Welcome to Credentialing

      Welcome Email: The welcome email will be sent from the Modio/ OneView secure credentialing platform once you have obtained the contact email for the administrator (if group credentialing) OR provider (if individual credentialing).

      • Log into Modio OneView

      • Click on Team Dashboard

      • From the provider listing in teams click the envelope to send the onboarding invitation

      • Ensure the email address is correct

      • Select “Onboarding Template”

      • click SEND

      NOTE: Forms are sent separately. Anything needing a signature like a TAF must be sent from FORMS section separately.

      Forms through Docusign:

      • From Modio click Forms

      • click on the envelope next to the TAF form (or other form you need to send for signature) NOTE: the envelope prefills the form with the info you select.

        • TAF- Transfer of Authorization (Required for all)

        • Collaborating /Supervising Physician Approval form (for all providers that are not MD, DO, LPC or PhD. )

        • Credentialing Data sheet (ONLY for providers that refuse to fill out online profile)

        • Demographic Change form ( for all demographic updates or changes)

        • Payer list (for all payer lists that have TBD in contract)

      • enter “prefill form for” - you will select the provider you want prefilled data added to that form (Name, NPI, etc. )

      • Send form to: mark Myself ( this pushes the document to you for editing prior to assigning to someone else “provider” for signature or completion.)

      • Select new signer: usually the provider email

      • Email Subject: enter form name as subject

      • Email message:

      Dear [first name] or [Dr. name],

      Attached is the form we need completed. Please take a moment to complete and return this as soon as possible. Please reach out if you have any questions or feel free to click on “Chat” from Modio to speak with a live agent for assistance.

      Thanks so much

      Your Prime Credentialing Team

      • Click Send

      • Monitor status in “envelope” send window.

      • When complete it will be in documents folder under “completed forms”

      Welcome Call:  The Welcome call should be utilized to go over introductions, review the agreement, the payer list, all specific practice/ provider details, timelines, what to expect and next steps. This call should be scheduled within 1-2 business days of being assigned a new credentialing client. After review of client specifics, you will then send one of two below templates to assist with scheduling this call:

      Note: Remember to mark the appropriate Credentialing Action in Hubspot ticket once action is completed- Send Welcome email

      • Credentialing Welcome - Smart Start

      • Credentialing Welcome - A la Carte/ Maintenance

      Schedule the Welcome Call with the client and internally to accommodate the CAM on the initial 15 minutes of the call. Use the Welcome call template that is most appropriate- above.

      Note: Remember to mark the appropriate Credentialing Action in Hubspot ticket- Schedule Welcome Call

      • In case of a Smart Start also refer to the Onboarding SOP for this welcome call.

      Review New Credentialing Client ticket:

      • A new Credentialing ticket is created upon sign up by Deal Desk or the sales associate and assigned to the Implementation Specialist.

      • Once the ticket is assigned, the Specialist will need to ensure there is a clear understanding of the service purchased by reviewing the credentialing service order and any deal specifics. The deals are in the right-side panel of the company record in HS.

      • The signed agreement will be in the attachments inside the deal. DO NOT DISCUSS THE DEAL, PRICING, ETC. Refer the client back to sales if needed.

      • Sale Associate is REQUIRED to include the provider or practice contact email so an invitation to the secure credentialing portal can be sent.

      Conduct Welcome Call: Initiate the Welcome Call and introduce yourself and review the previously edited slide deck. Welcome Call Info Slide Deck

      • The implementation specialist will review the Required Credentialing Document Checklist and remind provider/ Admin to upload documents to Modio secure portal. (only obtain required documents that DO NOT have the notation “if applicable” on them)

      • The Implementation specialist will review portal and audit all information in Modio to ensure we have all payer logins needed to proceed.

      Completed Welcome Call: Once the Welcome Call has been completed you will then send the recap using the below template:

      • “Credentialing Welcome Call Recap”

        • This template is used to recap all credentialing welcome calls for the client

        • Include / attach the slide deck used during your call.

      ADD PROVIDER/ FACILITY IN MODIO- 

      If we are ONLY working on a group and not an individual provider, please create Facility per process and not provider. This will mean you will send invitation for the group to the contact person on file in Hubspot. If questions exist or you are unsure how to process, please contact a manager. 

      From the “Team” Dashboard:

      • Click “Add Provider”

        • Enter Provider name (first and last) and click “Don’t see profile listed? click here to skip profile claim.”

        • Select providers title

        • Enter Specialty

        • Enter Provider email

        • click “Save”

      Step 2:  Credentialing –Modio OneView

       Modio Secure Portal

      Modio Invitation

      The invite should be sent from Modio SEE ABOVE “WELCOME EMAIL” FOR HOW TO SEND THE INVITATION.

      Modio Follow up

      You will need to follow up with the provider/ practice every 1-2 business days until Prime Credentialing has received complete information in the portal.

      Within two days of conducting the welcome call, please contact the provider/ practice or primary contact for check-in to see how things are going. Offer assistance /guidance to the customer with the EddyOne application so they can start adding the information in the system. (users can also use the “live chat” feature from Modio to get help with the portal if needed”.

      • Missing Document/ Info Notices: you will need to send notice of missing information to the provider and or practice if they have not provided complete information via Modio portal.

        • 1st Notice: send template named “Credentialing Customer follow up missing docs 1st notice- Intake”

        • 2nd Notice: send template named “Credentialing Customer missing documents 2nd notice – Intake”

        • Final Notice send template named “Credentialing Customer Missing docs FINAL Notice – Intake”

      There may be occasions (like maintenance customers) who you will send 3rd, 4th, 5th and sometimes more notices to provide missing information- if this occurs please ensure management is aware.

      Please Remember to mark the appropriate Credentialing Action in Hubspot ticket- Required documents Received

      Audit of Modio data: you will be required to review each Modio profile section and audit all profile data and submitted documents to ensure all are complete and unexpired.

      • Once the Modio Audit is complete you will need to ensure the credentialing ticket is marked completed by updating the Hubspot ticket.

       From the team dashboard click on the provider you are auditing and review each section for complete information.

      Once you have validated the section you will place a checkmark in the box as seen below, note that any section without a checkmark is INCOMPLETE and a reminder should be sent to the provider/ practice to complete them.

      Please ensure all required documents are attached in the document section as well. 

      • Update the ticket as follows:

        • Audit complete field and enter YES

        • Audit Date- enter date that you checked and validated Modio data is complete

      Please Remember to mark the appropriate Credentialing Action in Hubspot ticket- Intake materials reviewed

      Step 3: Notify CAM

      Client Ready for Credentialing

      Create Credentialing Status Ticket:

      • A new Credentialing Status ticket is created and assigned to the CAM to begin working and building applications, research payers, making demo changes, etc.

      • If there is no CAM / CSR listed in the field under the company record, please reach out to the credentialing team manager for updates.

      • Place appropriate description in ticket (usually same as what was in your ticket) and change the owner of the ticket to the CAM assigned to the account/ company.

      REMINDER: All emails for credentialing onboarding and statusing must be sent from Hubspot using templates if possible. It is important to use these templates because they contain forms, links and all notice markers needed for successful onboarding. 

      1. Click Add Ticket from the company record

        1. Ticket Name: CREDENTIALING+ Account Name (for Maintenance clients use “MAINTENANCE+ Account name)

        2. Pipeline: Credentialing Status

        3. Ticket status: use default- DO NOT Alter

        4. Ticket Type: Credentialing

        5. Description: Add details including service contracted for, provider names, etc. ( many times you can copy and paste the description from the credentialing onboarding ticket)

        6. Source: leave blank

        7. Ticket Owner: Credentialing Account Manager Name ( if not listed in company record contact credentialing manager)

        8. Priority: Low (always start at low)

        9. Company: ensure the proper company name is listed (when selecting the company to create the ticket from be sure you are in the correct practice- look for parent account if needed)

        10. Contact: Select the contact that will be receiving credentialing status updates  

      2. Click Create

      3. Please add any notes related to start date of demo change, or other important info.

      Upon assignment of the Credentialing Status ticket, the new CAM will receive an automatic email from HS that a new account was assigned. **Chatter “@name of manager” in the ticket notes to alert the credentialing manager to update tags in Modio”

      Account Assignment: In Hubspot on the company record, you will find the credentialing assignment fields. Click to “View all Properties” from the Company and search “credentialing” to locate the CAM, CSR, sign up/ start dates and whether active and / or maintenance client.

      Step 4: Timeline for Credentialing Onboarding

      Timeline:

      The recommended timeline for follow up with the credentialing primary point of contact is daily until completion of the intake process. Follow up should always be done by email using the templates and by telephone ( all calls must be documented in Hubspot call log). Practices and providers must use Modio to upload all correspondence and required documents. Please let them know that any documents sent in email are 1) not secure and 2) will not be considered as delivered for credentialing purposes. We will NOT accept required documents via email.

      If you do not have all documents:

      • Send missing document notices per the above Step 2 every 3-5 days

        • Credentialing Customer follow up missing docs 1st notice within 3 days of welcome call.

        • Credentialing Customer missing documents 2nd notice within 5 days of welcome call.

      • If the practice is nonresponsive after 2-3 attempts (approximately 7 days from welcome call or 2 days from previous request) Notify manager of non-responsive customer.

        • Send a final notice email using the proper Hubspot email template. This gives the client 10 days to respond or cancellation of credentialing services will begin. **Do Not Send to Maintenance customer without Manager Approval**

      CREDENTIALING CANCELLATIONS

      If your client has not responded after sending FINAL 10-day notice to terminate, please document ALL attempts to contact them via the ticket and notify your manager so we can begin termination of the client.

      Note: For Smart Start packages, please refer to the RCM Onboarding SOP for OON billing and required documents. OON Agreement (Billing Prior to Credentialing Completion)

      Forms for use: Majority of the forms are already in email templates in Hubspot. Any required forms such as Demo Change or HPI Credentialing Sheet must be uploaded to Modio.