Recredentialing Due Report
On or around the 1st of every month, Gemini will publish a Recredentialing Due report, which will consist of Client Providers and HDOs coming due for Recredentialing within the next 3-6 months (Client specified), based on the Credentialing Approval and Next Recredentialing Due date (2 or 3 year Recredentialing cycle as Client specified) provided by the Client for its Providers, as required for Gemini's Recredentialing tracking/management service. Client Users will be notified via email directly or by indicator on the Dashboard of the Client Portal when a new month's Recredentialing Due report is available and in need of reconciliation and submission.
Within 30 days upon publishing of the Recredentialing Due report, found in Current Reports in the Recred Due report section, the Client will be responsible for the following:
1. Carefully review the report and indicate Action To Take for each Provider accordingly.
2. Confirm / Edit (as applicable) contact information shown for each Provider, which will be utilized in applicable Provider outreach attempts needed during the Recredentialing application retrieval process.
3. Confirm / Edit Client or Provider specific information shown for each Provider, which may be utilized in how an application is retrieved or which application source is used.
3. Add Providers not showing on the report, yet deemed due for Recredentialing by your organization, using the functionality provided within the Recredentialing Due report.
4. Attach Privilege Forms (Hospital Clients ONLY) or indication of Privilege Forms Not Required.
5. Submit final and reconciled Recredentialing Due report as authorization for Gemini to proceed with the Actions indicated.
* Provider additions/indicated actions, edits, reconciliation and final submission of the Recredentialing Due report as a whole, as well as individual Provider information edits within, is the sole responsibility of the Client. Gemini Diversified Services will not be responsible for the start of the Recredentialing process nor Provider Recredentialing compliance issues caused by unlisted Providers not added/appropriately reconciled upon final submission by Client.
Functionality Available on the Recredentialing Due Report and Submission Requirements:
Download Recredentialing Due Report (CSV or Excel) - The Recredentialing Due report is downloadable in CSV or Excel formats. The suggested usefulness in downloading the Recredentialing Due Report in one of these formats is that the report may then be sorted, ingested into or crosschecked in bulk with an internal Client database, fragmented and distributed to departments/personnel within the Client organization, etc. in order to gather Provider reconciliation information and Action. The downloaded Recredentialing Due Report is for working purposes only and is not bidirectional, in that changes made to the Recredentialing Due Report download, may not be uploaded and applied to the Portal Recredentialing Due Report.
Search - Within the "Filter Providers:..." section on the Recredentialing Due report page, the User may search for an individual Provider. The suggested use for the Search feature is for speed and convenience in information look-up or taking actions offered within the Recredentialing Due report. Searches may be performed by Name, NPI Number, Specialty, etc.
Use CAQH - The User may indicate, by toggling on (green), that Gemini query the CAQH as its source for the Provider's Recredentialing application. Should the User select the CAQH as the Recredentialing application source, no other method of application request will occur (prepopulated application). Should the User NOT select Use CAQH, Gemini will prepopulate and send to the Provider, the Client-specified Recredentialing application packet. NOTE: A CAQH number must be present/entered in order for the User to select Use CAQH.
Action To Take - The User will be required to indicate to Gemini as to how to proceed with the Provider identified to the Client as due for Recredentialing. All Providers are defaulted to Start Recred for convenience, particular in the case of a higher volume Recredentialing Due report.
A. Start Recred - Confirms that the Provider's information has been reviewed and reconciled, if applicable and authorizes/directs Gemini to proceed with the Recredentialing process, which starts with the application gather procedure (i.e. Provider CAQH query or prepopulated application send out).
B. Terminate Provider - By selecting Terminate Provider, the User may terminate that Provider, which requires a termination date entered and a stated reason for termination (optional).
C. Reschedule Recred - Should the User wish to reschedule a Provider listed within the Recredentialing Due report to a future month, instead of starting the Recredentialing process in the immediate, the User may select the Reschedule Recred action for the Provider. Once Reschedule Recred is selected the User must enter the newly desired Next Recredentialing Due date within the calendar (month/year may be toggled right). The User may freely type a reason for the reschedule which is strictly documentation for the User for the purpose of reference of the rescheduling. NOTE: The User may only reschedule a Provider to a future date and should not reschedule to a month of a Recredentialing Due report already published. Doing so will be cause for the new Next Recredentialing Due date to go unidentified by Gemini and the Recredentialing process may not be started for the Provider.
+Add Provider (Existing Client Provider in Gemini1) - There may be instances whereby upon review and reconciliation of the Recredentialing Due report, the User will identify that should be showing as due for the month of that particular month's Recredentialing Due report, but is not showing. This may occur due to the fact that an approval was not performed for the Provider and therefore still in a "Complete" status or status other than "Approved" and therefore, the Provider was not detected by Gemin1 for add to the Recredentialing Due report OR the User may wish to initiate the Provider's Recredentialing sooner than the Next Recredentialing Due date shown for the Provider in Gemini1. In order to add a Provider already existing and associated to the Client in Gemini1, the User will 1) Search the Provider being added in Gemini1 to insure that the Provider exists as Client associated AND is in an "Approved" status (If Provider is not in an "Approved" status, the User must first provide an Approval / Next Recredentialing Due date for the Provider (See Updates-New Upload-Approvals or Provider Inventory Report Articles) 2) Return to the Recredentialing Due report and select +Add Provider 3) Type in the Provider's name to search and select the Provider to be added 4) Enter the Provider-to-be-added's Recredentialing Due date (this date may only be within the month of the Recredentialing Due report being added to) 5) Select +Add 6) Review and reconcile the Provider's record (contact information, designation, CAQH number, etc.), if applicable, as the added Provider will now show at the bottom of the Recredentialing Due report. NOTE: Attempting to Add a Provider to the Recredentialing Due report that is in a status other than "Approved" in Gemini1 will trigger an error message to the User: "Credentialing Cycle already exists" and therefor the User MUST perform Step 1 herein and then return to the Recredentialing Due report to re-attempt the Provider add. If the Provider-to-be-added was previously terminated and in a Terminated status in Gemini1, the Provider MUST be submitted through as a New Upload (Updates) - Credentialing Application - See Updates - New Upload - Credentialing Application Articles.
+Upload Provider (New Provider NOT Existing in Gemini1) - There may be instances whereby the User wishes to Add a Provider to be recredentialed to the Recredentialing Due report, that does not currently exist in Gemin1 as associated to the Client. This may potentially occur when the Provider was initially credentialed in-house (not credentialed by Gemini) and now the Client/User wishes to have Gemini perform Recredentialing services for that Provider. This will require that the User enter all required Provider information, necessary to establish a Client associated Provider record in Gemin1 and subsequently perform pre-populated application send out, CAQH application query or Provider outreach during the application gather process. In order to add a Provider that does NOT currently exist as an associated Client Provider in the Gemini1, the User will 1) Select +Upload Provider 2) Toggle on (green), HDO, if the User is adding an HDO Provider to Gemini1 3) populate ALL Required* fields 4) Select green Upload bar. The uploaded Provider will now show at the bottom of the Recredentialing Due report.
Privilege Forms - (Hospital Clients ONLY) - Hospital Clients are REQUIRED to attach privilege forms to EVERY Provider listed for Start Recred upon submission of the Recredentialing Due report. Privilege forms must be attached as single document, in pdf format only and will ultimately be included in the Hospital Client's Recredentialing application packet that is sent to the Provider. Should the Client not require privilege forms be competed by the Provider at Recredentialing, the User may toggle ON (green), Privilege Form Not Required. This will circumvent the requirement for attaching of privilege forms for that Provider. NOTE: User will not be able to submit the Recredentialing Due report if any Provider does not have either a pdf privilege form attached or the Privilege Form Not Required toggled ON (green) , as it is a REQUIRED field.
Submit - The User MUST select Submit only after finally and completely reconciling the Recredentialing Due report as authorization for Gemini to proceed with the Actions indicated. Once the Recredentialing Due report is submitted it may not be edited. Should there be additional edits or additions, please contact a Gemini representative.
View Older Reports - Once the Recredentialing Due report is submitted, the User will have record of changes that were made to previously submitted Recredentialing Due reports, listed by month in the Completed Reports section. Once the Recredentialing Due report is submitted it may not be edited. Should there be additional edits or additions, please contact a Gemini representative.
Editable Fields on the Recredentialing Due Report:
Provider Name - Client-specific name
NPI Number - Individual Provider's NPI1 Number (only available for editing if not shown)
CAQH Number - Unique ID number rendered to the Provider by the CAQH (only available for editing if not shown). NOTE: If Client utilizes the CAQH as its only source for Gemini's retrieval of a Recredentialing application AND a CAQH number is not shown or entered and submitted by Client User, upon submission of the Recredentialing Due report, Gemini1 will automatically send a notice to the Provider requesting his/her establishment of a CAQH account and/or a request to provide his/her CAQH number to Gemini to start the CAQH application inquiry process. Gemini's CAQH Recredentialing application gather process is automated and requires a CAQH number in order to begin a query directly from the CAQH. It is strongly suggested that the CAQH Only Client User provide a CAQH number if not shown in a Provider record within the Recredentialing Due report ( **CAQH numbers may be obtained by the Client User by logging into the Client's CAQH ProView account and searching the Provider by name/NPI Number).
Primary / Sub-Specialty - Provider related specialty(s) specifically contacted by your organization
Client Designation - Client-Provider contracted role (PCP, Specialist, Allied, etc.) - NOTE: Client Designation is REQUIRED for Client utilizing varying application versions depending on whether or not the Provider is designated as Allied vs. Non-Allied. The designation selected / submitted by the Client User within the Provider record will drive which application version is pre-populated (only applicable to Clients utilizing a pre-populated application with varying versions for Allied vs. Non-Allied)
Client ID Number - Client specific identification number
Standalone (Applicable Only for Alliance Model Clients) - Indication that the Provider, despite overlapping in multiple groups (Linked Plans), within Alliance models, Managed Service Organizations (MSO) type Clients, does not share the earliest Recredentialing Due date but keeps the Clients specific Recredentialing Due date, either permanently or over one Recredentialing three-year cycle (One-time)
Contact Details - The Address / Contact information shown within the Provider's record is the contact information on file with Gemini (Priority: Credentialing or Primary Office, if Credentialing Contact is not on file) and is the Address / Contact information that will be utilized in applicable Provider outreach attempts needed during the Recredentialing application retrieval process. If no address is shown within the Provider record, one MUST be added by the User (User will not be able to submit the Recredentialing Due report if any Provider does not have an Address / Contact Information selected, as it is a REQUIRED field. Upon submission of the Recredentialing Due report, if a Provider is missing Address / Contact Information, an error message will appear indicating such and the Provider record missing the Address / Contact Information will be highlighted in RED within the report.). The User has the option to edit/add/replace the Address / Contact information in one or more of the following:
A. Remove and Replace Entire Address / Contact Information with an Address / Contact Information Existing in Gemini1 - Should the Address / Contact Information shown for the Provider be in need of an entire Replacement, the User will 1) Select and confirm Remove, which will remove the Address / Contact Information shown for the provider. 2) Next, the User will click on EDIT, next to Contact Details. The User will then either select from the addresses either already associated to the Client or select and associate from the general address bank for that Provider in Gemini1. 3) Once the desired address is selected, the User MUST choose/designate the Type address being selected (The User may also choose the preferred method of contact). 4) Once 1-4 is performed, the User MUST click Add and the newly selected Address / Contact Information will be shown for the Provider.
B. Remove and Replace Entire Address / Contact Information with an Address / Contact Information NOT Existing in Gemini1 - Should the Address / Contact Information shown for the Provider be in need of an entire Replacement, the User will 1) Select and confirm Remove, which will remove the Address / Contact Information shown for the provider. 2) Next, the User will click on EDIT, next to Contact Details. 3) The User will then either select Create New (desired address / contact information cannot be found from the addresses either already associated to the Client or select and associate from the general address bank for that Provider in Gemini1). 4) User will now populate ALL Required* fields. 5) Once 1-4 is performed, the User MUST click Save and the newly selected Address / Contact Information will be shown for the Provider and Associated to the Client.
C. Edit the Address / Contact Information Shown WITHIN the Contact Details Section - The Provider address / contact information shown or newly added/replaced by the User may require editing of the information within that address / contact information (i.e. address, phone and fax showing correctly for a Credentialing Contact, however the User recognizes that the email address may be outdated and requires editing to include an updated email address). To make changes to the address / contact information shown within the Provider record, the User will 1) Click the Edit (Pencil icon) WITHIN the address / contact information section, 2) Edit fields as desired 3) Select Update (Green bar).
Client Designated Email - The Client designated email provides the User the option to keep the Provider's current address / contact information, but circumvent it and specify a specific email address which will be utilized in applicable Provider outreach attempts needed during the Recredentialing application retrieval process (i.e. Provider is a Medical Director, privately practicing at the Primary address shown in the Provider's record, however the User desires the Recredentialing application / outreach notices sent to an email address within the Client's internal system instead of the Provider's practice.
*** If the Recredentialing Due Report shows no Providers on the Report and states "No Providers are due", the User MUST still select Submit only after finally and completely reconciling internally to assure no additions to the report are needed to be made by the User (See Add Provider and/or Upload Provider functionality guide).