Five Steps to Expedite the Payor Enrollment Process
Payor enrollment is a diverse and ever-changing process. With so many rules and regulations in place, it can take several weeks - and even months - to get applications approved. By developing an efficient payor enrollment process, you can ensure your provider’s applications for medical staff appointment and privileges and enrollment in health plans are processed as quickly as possible.
Making sure your applications are complete is just one of several important steps you can take to optimize efficiency as a payor enrollment specialist. Here are five additional steps you can take to speed up the payor enrollment process:
- Verify professional practice questions – To further verify their mental and physical health, providers may be asked to answer professional practice questions, such as whether or not their mental and physical health is such that they are able to provide safe patient care services, and whether there has been any disciplinary action taken by healthcare facilities, licensure boards, etc. It’s important for the provider to review these questions before submitting the application to ensure they are answered correctly, as they will ultimately be held responsible for their answers. And don’t assume you know their answers—some providers may have experiences from their past that you don’t know about. It’s best to discuss these issues in advance.
- Contact peer references – Contact all peer references to let them know the provider listed them as a peer. Confirm their contact information and make sure they are comfortable being listed as a reference. After all, they will ultimately be asked to help verify the provider’s competency. Ask them to please respond promptly to the request and make sure they will not be out of town for an extended period.
- Obtain names of program directors – The health care facility will verify all relevant training, particularly if a provider recently completed a training program or advanced fellowship. They will obtain documentation of the approved residency or fellowship by contacting the program director. To expedite the enrollment process, keep this person’s contact information on file. This will make it easier to verify the provider’s training and professional education.
- Save copies of Continuing Medical Education (CME) information – You may need to provide proof of CME along with the hospital application. In addition, if the provider attended training courses for a new procedure or technique, it is important that the documention be maintained. Compile a list of all necessary documents associated with the provider’s training to help speed up the privileging process.
- Leverage resources - The ability to cross-reference files with a continuously updated payor enrollment system can help streamline your processes and maximize efficiency. Explore opportunities to automate your processes using cloud-native software solutions to identify and resolve potential administrative issues before they impact your provider reimbursements.
With the right systems and tools in place to expedite the payor enrollment process, you can generate and maintain revenue faster and more efficiently. To learn more about expediting the payor enrollment process, listen to the symplr webcast, How to Avoid the Payor Enrollment Black Hole.
Greatly reduce your payor enrollment wait time and start generating revenue faster with Payor Enrollment Services by symplr. 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 email@example.com.
About Kathy Matzka
Kathy Matzka is a speaker, consultant, and writer with 30 years of experience in credentialing, privileging, and medical staff services. Her clients represent a variety of healthcare organizations, including hospitals, long-term care facilities, managed care organizations and physician practices. She has also worked extensively with the National Association Medical Staff Services’ (NAMSS) Library Team, developing and editing educational materials to help organizations meet the rigorous standards and expectations of today's healthcare industry. She is one of the first recipients of the NAMSS Fellow Designation. The Fellow Designation is the pinnacle of achievement and acknowledgment for the Medical Services Professional (MSP), recognizing a career MSP who has made outstanding contributions to the profession through service as a leader, mentor, and educator. Kathy’s experience as an expert witness for almost 50 negligent credentialing claims offers unique insightinsights into steps healthcare professionals can take to mitigate the risk of negligence in credentialing.