SHANMEDTECH | PROVIDER ENROLLMENT PLANNING CHECKLIST
Business planning worksheet | Version 1.0

Purpose: organize application stages and ownership. This worksheet does not
collect provider identifiers, licensing documents, signatures, banking details,
or patient information. Keep such records in separately approved systems.
Payer requirements and participation decisions must be confirmed with the
applicable payer or program; this is not a universal application checklist.

1. DEFINE THE ENROLLMENT REQUEST
[ ] Identify whether the work concerns an individual, group, or location.
[ ] List the payer or program names and the requested participation context.
[ ] Separate new enrollment, updates, revalidation, and renewal work.
[ ] Name the practice contact authorized to verify information and approve.
[ ] Confirm whether work depends on another application or entity record.
Request category: __________________ Responsible role: ______________

2. MAP REQUIREMENTS WITHOUT COPYING SENSITIVE DATA
[ ] Identify the current payer/program source for requirements.
[ ] Track required document types and the party responsible for each.
[ ] Identify items requiring attestation, signature, or practice approval.
[ ] Record where approved versions are stored, not the documents themselves.
[ ] Establish who checks for incomplete, expired, or inconsistent information.
Requirement still unclear: __________________________________________

3. TRACK APPLICATION MILESTONES
Use an approved internal tracker for sensitive or account-level references.
[ ] Preparation underway
[ ] Waiting on practice information
[ ] Ready for authorized review
[ ] Submitted through the approved channel
[ ] Payer acknowledgement received, where available
[ ] Additional information requested
[ ] Payer decision received
[ ] Effective date or participation status separately confirmed

4. DEFINE FOLLOW-UP
[ ] Assign a follow-up owner and review point for each application.
[ ] Preserve source references in the approved tracker.
[ ] Route missing-item requests to a named practice role.
[ ] Escalate conflicting status information rather than assuming approval.
[ ] Distinguish application submission from acceptance or participation.

5. HAND OFF TO OPERATIONS
[ ] Confirm the payer's final status and any applicable effective date.
[ ] Identify the team responsible for updating operational records.
[ ] Communicate unresolved restrictions or dependencies to the right owner.
[ ] Identify future deadlines and who maintains the reminder process.
Next business decision: _____________________________________________

Submission is not approval. No processing time or participation outcome is
promised by this checklist. Verify the actual scope and payer-specific process.