Three Reasons to Consider Outsourcing Payor Enrollment

Your staff is shrinking, the workload is growing and your healthcare organization has acquired a practice with 50 new providers. How do you get them onboard, enrolled with payors and credentialed by the end of the fiscal year?

As a payor enrollment professional, you know that the credentialing and enrollment function payor enrollment.jpgpresents a major challenge to your staff with its paperwork burden, rigorous regulations and ever-changing processes that can wreak havoc on your onboarding timelines and revenue planning.

Just when you think you’ve reached a point when you have tapped every internal resource possible but payor enrollment is not meeting your timelines or expectations, it’s time to consider external resources at your disposal to help you achieve success at getting providers ready to see patients.

Here we’ll cover three instances when you may want to consider outsourcing your payor enrollment functions to help make your systems more efficient, your staff more productive and your revenue cycle healthier.

1. When you seek increased efficiency

Let’s review the scenario above, in which you are responsible for onboarding 50 new providers by a certain date. When you contact the payor enrollment consultants, you will find that their advanced technology and established payor relationships can help streamline your process. With proven software solutions and networking advantages, their services are designed to save time, which can result in applications being processed in 25 to 50% of the time it takes when handled in-house. In addition to the relationships, the advanced technology and workflow processes utilized by consultants ensures the consistency, accuracy and timely submission and delivery of all applications and forms.  An additional benefit to outsourcing includes regular and proactive status reporting, so you’ll know the exact day a provider becomes effective, which will enhance your revenue planning.

2. When you want to reduce labor costs

Even with several staff members dedicated to the credentialing and enrollment process, why does it seem like payor applications take much too long to process? In all likelihood, the team tasked with handling payor enrollment also has a number of other responsibilities within the organization. In addition to competing priorities, as your organization flexes and grows, more and more work is expected from a limited number of administrative employees. When your goal is to enhance and maintain a robust, compliant and efficient payor enrollment process that consistently meets your organization’s expectations but you can’t hire more staff, consider contacting the consultants.  With the right specialists and processes in place, you will find that outsourcing this function provides a cost reduction to your department both in the short and the long term.

3. When your focus is on quality and compliance

In the scenario outlined above, you may realize that your staff’s current workload is unsustainable, leaving little room for improvement or handling an additional workload. Your concern is that this situation could open the door to delays or missteps in applications being processed and providers being enrolled into the health plans properly. Not only could the quality of the enrollment and credentialing process be at risk, but also the time-sensitive and compliant process of onboarding new providers. By outsourcing the process to trusted payor enrollment consultants, you can be assured that the top priority of your department—ensuring best practices for your payor enrollment processes—and the quality of the organization, are not compromised. When you contract with professional services, you can avoid the errors or missteps inherent within the payor enrollment process, while ensuring you are meeting the highest standards of quality and compliance. Consultants also stay up to date on new legislation in the healthcare arena and are knowledgeable about all the changes affecting enrollment on both the federal and state levels, which can provide an additional level of confidence about their process.

As payor enrollment continues to grow more complex, you may have even more reason to consider outsourcing this process. Be assured that trusted payor enrollment experts can help you achieve your goals when you know it’s time to make a change for the better.

To learn more about navigating the payor enrollment process and how outsourcing enrollment services can benefit your organization, download the symplr white paper, Navigating the Payor Enrollment Process.Payor Enrollment from 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 protected].


Susan Ward

About the Author
Susan Ward

At symplr, Susan Ward is the Director of the Payor Enrollment Service product line. With 20+ years’ experience in physician practice management and provider enrollment, Susan is responsible for enrollment operations and relationships with Healthcare Systems, Hospitals, Physician and provider groups focusing on increasing the efficiency of provider onboarding during acquisitions, employment or new practice start up. Her previous experience includes over nine years at Community Health Systems in Franklin, TN, where she served as the Manager of Provider Enrollment, Acquisitions and RHC Enrollment. Her strengths in organizational structure, problem solving and relationship building, as well as her background and knowledge of CMS guidelines, are an asset to Payor Enrollment Services.

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