Picture this scenario: As the enrollment specialist in a group practice, you find out that your group has hired a new provider. You also learn that this provider is already a well-established practitioner in the area, and that the provider is merely “moonlighting” with your practice. How will this affect the way you approach this enrollment? What are some of the concerns in enrollment that may arise? Can you avoid these potential issues?
Unless you are armed with the expertise and a process, enrolling a new provider can cause problems, from the provider’s tax ID being terminated to payments going to the wrong location. Payments to either the provider’s primary practice or your group could also be halted altogether. When you are ready to start the enrollment process, do you know the right questions to ask both the provider and the payors involved? Following are some tips to make the enrollment for a new provider with an existing practice a smooth process.
As the enrollment specialist, it’s important that you do your due diligence and ask questions that will guide you in the enrollment process and the way you establish the new provider’s relationship with payors. It is key to determine the provider’s current work status and if he or she has any existing employment relationships that may affect how to manage the enrollment.
In this case, the provider has an existing private practice and is joining your group for coverage—a very common occurrence within hospitalist groups. It’s essential that you understand what the payors want to know about this new provider and that you follow a process. The risk in not following the correct enrollment process for this new provider is that mistakes made in submission of data may halt the credentialing process, and/or change information in their current profile, directly impacting reimbursements for the provider or the practice.
The enrollment specialist should be aware of all the details related to the new provider that could affect how the provider is to be enrolled. A best practice is to do your research. Reach out to the provider to request information, such as current documents and points of contact. Being aware of the other relationships the provider has is important as well. Additionally, you will want to clarify the provider’s primary office’s tax ID number—which will be different than the tax ID number of the additional practice—this number is the one that will be used for enrollment and reimbursement. It will be equally important to verify that the NPI number for the provider is his or her individual (Type 1) NPI and not his or her organizational (Type 2) NPI.
Reach out to the payors and review the provider’s record in CAQH. If you are contacting the payors to confirm information in the provider’s profile, you will note the provider’s past and existing relationships; these should remain untouched in the record. You’ll want to ensure that a payor has the same information about the provider that you do, and that these previous, existing data points remain in the provider’s profile and are not changed or deleted.
When starting the enrollment, the enrollment specialist should not alter the provider’s primary profile, change his or her primary billing, or update any contracts related to that practice. The only action to be performed is to add your clinic/place of employment as a new location, along with the additional tax ID and associated information, into the provider’s record. This is the appropriate way to create another relationship with the payors and to get the provider correctly affiliated with the new practice without disrupting his or her primary practice.
The provider should make sure the primary practice is aware of the additional arrangement. Also, make sure there is a clear line of communication regarding the sharing of information. He or she should make sure all documents are current and shared with the additional group. When communicating with the enrollment specialist, the provider should clarify that this is an additional arrangement and does not terminate or change his or her primary practice affiliations.
With just a small amount of effort, linking a provider to an additional group practice can be accomplished easily and without issue, leading to timely billing and reimbursement for your group.
We offer complete client support to help you navigate the complexity of provider enrollment, saving you time and money. Learn more about Payor Enrollment Services at www.symplr.com/products/payor-enrollment-services or schedule a demo at firstname.lastname@example.org.