Bad debt associated with provider credentialing results in lost revenue for UCSF Health. Claims submitted to Medicare, Medi-Cal, and California Children’s Services (CCS) are denied if providers are not enrolled when they treat our patients. These denials result in lost revenue. Our Health Plan Enrollment (HPE) analysts manage claim denials for revenue associated with credentialing. Providers must be enrolled in Medicare, Medi-Cal, and CCS by the date UCSF’s Governance Committees (GAC) approve their privileges. HPE identifies new providers, reports on a monthly Credentials Committee Report, and proactively enrolls them before they treat patients. But we need to work in partnership with the providers to ensure timely enrollment!
How providers (especially Residents/Fellows) can help us enroll you in a timely manner and avoid bad debt:
During Initial Application:
Update any changes to provider taxonomy and new practice/contact addresses in NPPES - If you don’t remember your User Name or Password, you will be redirected away from NPPES Website to Reset your User Name and Password. When you are done, return to NPPES to log in and apply for or view/modify your NPI
Return original signature pages (preferably signed in blue ink) for Medi-Cal enrollment. The Department of Health Care Services (DHCS) will not accept faxed/pdf copies. Please contact your HPE analyst if you have questions:
E-sign your 885R/I Medicare enrollment forms within 48 hours of receiving an email from your HPE analyst. Our HPE analyst will provide your User ID and password (sent in a separate email). You will be directed to go to Medicare Provider Enrollment, Chain, and Ownership System (PECOS).
Ongoing:
Update any changes to provider taxonomy and new practice/contact addresses in NPPES - If you don’t remember your User Name or Password, you will be redirected away from NPPES Website to Reset your User Name and Password. When you are done, return to NPPES to log in and apply for or view/modify your NPI
Unlock your CMS I&A account if requested for Medicare enrollment. You will be directed to call e NPPES helpline (1-800-465-3203) between 8:00 am - 2:00 pm. You will need your NPI number handy.
Contact us when you become board-certified. Do not wait until your reappointment! HPE needs to update your specialty/taxonomy in NPPES to avoid claim denials. Other updates include name changes, practice address/telephone, etc.