When requesting participation in health insurance networks, are you familiar with “narrow networks”? This is an important new trend where payors attempt to contain costs by reducing the number of in-network providers and lowering premiums for enrollees. Typically, this brings great pressure on payor enrollment specialists, who are tasked with not only promoting their providers’ value, but also competing for network enrollment and reimbursement assurance.
No doubt, this cost containment strategy leads to a greater emphasis on the letter of interest as an essential part of the payor enrollment process. Don’t think of it just filling out paperwork – even though you are completing forms and providing credentials. When written effectively, the letter of interest can become a key selling tool to persuade a payor to offer enrollment in their health plan.
Where do you begin? For starters, here are eight important elements to include in your letter:
You must provide basic information about the provider, including his or her name, service address, NPI number, tax ID, Council for Affordable Quality Healthcare (CAQH) number, specialty and services provided. You must make sure the information matches the enrollment application.
Don’t forget to mention any defining characteristics, such as how long you’ve been in business and whether your organization is a family-owned business or corporation. It would also be worthwhile to reference if your organization is a minority or woman-owned small business.
You can also highlight any services that your provider offers that differs from competitors.
You should be sure to pinpoint the provider’s geographical location and, if applicable, identify that area’s relevance. For example, does your provider work in a rural area or an urban setting?
It is important to describe the patient mix, including low-income, Medicare/Medicaid eligible, special needs or Indian Health Services patients.
This is another way to differentiate your services from competitors. Depending on the provider type, you can include information about services available for referral, such as durable medical equipment, home health and/or hospice care.
This is where the rubber hits the road. Does the provider offer rates slightly lower than the competition? If so, be sure to include this in your letter to make the provider more appealing to the payor.
Remember, networks may already be at capacity when they receive your enrollment request. You may be able to win approval by offering them something enticing like a pilot or test program if possible.
Depending on the payor, you may also need to provide the following attachments:
Check your enrollment homework! And check it again! When addressing the letter, find the name and address of the key decision-maker or the person primarily responsible for managing the network once the enrollment contract is processed. There are several lines of attack to get this information – either by calling the payor directly or searching for contacts on LinkedIn. Once you have zeroed in on the appropriate person, you can submit your letter of interest along with your enrollment application and any necessary attachments.
How do you increase your chances of inclusion in certain health plans and gain reimbursement? For starters, make sure you’ve accurately identified what makes your provider unique from others in the market. You must also verify the accuracy of the information provided..
Don’t forget that while the letter of interest is arguably the most significant component in the payor enrollment process, it is only one step in the process. For step-by-step information on the complete payor enrollment process, listen to our symplr webcast, “Achieving Payor Enrollment Success.”