Healthcare Credentialing | symplr Blog

Roadblocks that Delay Provider Enrollment

Written by Patrick Birmingham | Oct 2, 2012 3:43:00 PM

No one enters medicine looking for the opportunity to fill out forms. Nevertheless, paperwork is an integral part of any successful healthcare practice or facility. Nowhere is this fact more evident than in complying with payor enrollment requirements. Numerous roadblocks can develop during this process that can delay your enrollment. The most common and problematic include:

Training Completion Documentation

The benefits of training are immediately evident to the practitioner’s patients. However, without the proper paperwork to demonstrate to an insurance company that you received and completed training, the enrollment process cannot be initiated. Hence, any services rendered are not guaranteed to be paid if performed while you are not a participating provider. It is essential that healthcare providers secure and maintain documentation required for submission to initiate provider enrollment and to update their status with insurance companies and other payors on a regular basis.

State Licensure, Federal Licensure, etc.

While the paperwork and procedures required for payor enrollment by private companies may seem monumental, they do not compare with the bureaucracy of state and Federal agencies. In addition to keeping your state license up to date, you will also have to deal with your CLIA certificate, DEA registration, CDS registration, licensure addresses, pay-to address, bank account information, and everything else that is required as any one of these can halt the entire enrollment process. In addition, when doctors, nurses or other staff members are selected for re-credentialing, licensure and supporting documentation must be current to navigate the entire process again.

Malpractice Insurance

Securing and maintaining the proper professional and general malpractice insurance coverage and keeping it properly updated is another area often overlooked or delayed, if not done properly and in a timely manner, can result in delayed provider enrollment process equating to more potentially denied claims.

Hospital Privileges

While traditional Federal programs such as Medicare, Medicaid and Tricare are not an issue, commercial insurance carriers and advantage plans require proof of hospital privileges at network facilities. Other options are available to help in the event hospital privileges have not been secured timely to allow for payor enrollment to be initiated, such as a covering physician of the same specialty or a hospitalist group who will admit on your behalf while pending the privileging process.

The Future and the Bottom Line

Properly dealing with these problems is essential for the timely enrollment of your practice. Some practitioners attempt to keep the process in-house but the vast majority relies on the expert services of third-party provider enrollment companies. Whether your practice is brand new, rapidly growing or expanding into new services and areas, a payor enrollment company can be a valuable asset. They understand the intricacies of the required paperwork and can save you time, money and aggravation.

The list of paperwork requirements is destined to grow over the coming years regardless of politics. The prudent healthcare practitioner should recognize this fact and develop a strategy to deal with the inevitable. Payor enrollment companies have the resources, the expertise and the experience to easily and thoroughly handle all your paperwork thus allowing you and your staff to concentrate on your patients.