Elderplan Credentialing and Compliance Updates

Elderplan Credentialing and Compliance: Key Updates Providers Must Know 

Elderplan has issued important reminders for providers regarding credentialing, compliance, and documentation requirements. Staying current with these updates is essential for maintaining participation in the network and ensuring uninterrupted reimbursement. 

Keep Provider Information Current 

Providers are required to maintain accurate and up-to-date information at all times. This includes address changes, contact information, office hours, and availability to patients. Failure to update records in a timely manner can result in claim delays, compliance concerns, or interruptions in network participation. Elderplan emphasizes that accurate provider data is critical not only for regulatory purposes but also for ensuring patients have proper access to care. 

Recredentialing Requirements 

All participating providers must complete recredentialing within the designated timelines. Missing recredentialing deadlines can jeopardize a provider’s status in the network and may lead to payment disruptions. Elderplan encourages providers to prepare documentation early and monitor notifications from the plan to avoid lapses. 

Annual Model of Care Training 

Elderplan requires all providers to complete the Annual Model of Care Training. This training ensures providers are aligned with the standards of care for Elderplan members, many of whom have complex or chronic conditions. The training is accessible through the Provider Portal and must be completed each year as part of ongoing compliance requirements. 

Documentation and Coding Standards 

Accurate documentation and coding remain top priorities. Elderplan highlights the importance of applying the **MEAT framework—Monitoring, Evaluation, Assessment, and Treatment—**when documenting chronic conditions. This approach ensures diagnoses are properly supported and coded, which is essential for care quality reporting, regulatory compliance, and reimbursement accuracy. 

Provider Portal Enhancements 

Elderplan has made several improvements to its Provider Portal: 

• Denial codes are now displayed directly in the system, making it easier for providers to understand claim outcomes and take corrective action where needed. 
• Providers can now download Explanations of Payment (EOPs) directly from the portal. This enhancement streamlines reconciliation and administrative processes for billing staff and practice managers. 

Elderplan’s recent updates underscore the need for providers to remain proactive in compliance, credentialing, and documentation practices. By completing recredentialing on time, participating in the required training, maintaining accurate records, and taking advantage of portal enhancements, providers can ensure smooth operations and uninterrupted care for Elderplan members. 

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