Managed Care Credentialing 101 (Recorded Webinar)

Date: Tuesday July 21, 2015
Time: 2:00 – 3:30 pm ET

Presenter: Deborah Ormay, CPCS, CPMSM

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This recorded webinar will introduce participants to managed care credentialing: Why it is done and how it differs from/is similar to credentialing and privileging performed in Medical Staff Offices. Participants will receive an overview of NCQA credentialing and recredentialing criteria. The webinar will identify resources that are available to insure compliance with NCQA standards and to promote understanding of the use of those standards.

Speaker Bio:

Deborah L. Ormay brings over 20 years of managed care credentialing experience to this webinar. Her introduction to credentialing occurred in June 1986 in her role as administrative assistant to the director of a Blue Cross-Blue Shield of Massachusetts (BCBSMA) staff-model HMO.  During her 14 year tenure at BCBSMA she earned her CMSC and joined NAMSS and MAMSS. She held a variety of positions within BCBSMA, each becoming increasingly focused on managed care credentialing and culminating as Lead Exception Review Analyst. As Lead Exception Review Analyst, Deborah brought initial credentialing and recredentialing applications into compliance with NCQA standards by working with the applicants to obtain missing information or explanations for non-standard responses from primary sources.

Since June 2009, Deborah has been working as a National Account Manager for United’s Delegation Relations Team where she has oversight of 55 delegates in a multi-state territory, assists the team’s regulatory and accreditation survey manager, and edited the team’s newsletter, “Delegation Delivers.”

What You Will Learn:

At the end of these presentations, participants will be able to:

  • Identify areas of commonality and disconnect between managed care credentialing and credentialing done by Medical Staff Services Professionals in hospital settings.
  • Describe four major steps involved in managed care credentialing.
  • Be familiar with a high level overview of NCQA standards.
  • Discuss the importance of collaboration between facility based credentialing professionals and managed care credentialing professionals

Who Should Attend:

All MSPs interested in the basics of Managed Care credentialing and recredentialing best-practices.

Cost:

NAMSS Members: $55
Non-Members: $75
Group Purchase: $150 (Provides access to the webinar and five (5) individual CE certificates)
Additional CEs (beyond 5): $85 per 10 additional certificates. Purchase as many packs of 10 as you need.

CE Credits:

This webinar has been approved for 1.5 CE Credits.