Customer Success Story


Payor Enrollment Services from symplr

ROI of Payor Enrollment Services

In just over 3 months, symplr’s payor enrollment services team helped a hospital system submit over $2 million to payors in backlogged provider billings and unreimbursed claims.

 

A middle-sized hospital system with four hospitals, 14 clinics, and several hundred providers reached out to symplr’s Payor Enrollment Services for assistance with payor enrollment for about 25 providers. These providers had been hired 6 months prior, but were never enrolled with their payors.

symplr’s Payor Enrollment Services identified a team to assist in correcting the enrollment errors and to research and fix other mistakes that had been made in the payor enrollment process for the hospital system.

As the payor enrollment specialists began to delve into the project, the team realized that the backlogged billings and unreimbursed claims had created a significant revenue shortfall.

THE SYMPLR APPROACH

symplr began a process that focused on enrolling the providers as soon as possible and fixing existing enrollment problems. In the long run, this will greatly help the billing department file and get paid for claims on hold.

symplr’s payor enrollment team started by researching each provider’s status, whether they were still employed with the system, and if the provider had reimbursements pending by using the accounts receivable reports. Based on the reports, symplr’s specialists determined which providers’ enrollment applications to focus on first. When the number of providers needing to be enrolled grew from 25 to 57, symplr’s scalable approach allowed them to add specialists to assist in the project. symplr met weekly with the hospital system team to report its results and notify them of the progress or issues they were facing.

The team also focused on correcting errors that had been made previously in the enrollment application process. When errors were corrected and providers’ applications were resubmitted, those that had been previously denied were processed and approved successfully with payors.

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In just 14 weeks, symplr’s Payor Enrollment Services assisted hospital system in getting over $2 million in backlogged billings submitted to payors.

In just 11 weeks, the hospital system was able to release and collect on more than $1.55 million of claims being held due to enrollment issues, which rose to more than $2 million after 14 weeks. The graph above illustrates the results. 

Within the first 30 days of starting the project, symplr’s payor enrollment team was able to deliver positive results and enroll 23 providers into 66 plans in which they could file claims. This timely, efficient enrollment and approval process set the stage for the claims to be paid quickly. 

Recognizing the value of symplr’s results, the hospital system continues to work with symplr’s payor enrollment team to enroll its newly hired providers.

 

KEY CHALLENGES

1. 25 providers needed to be enrolled with payors as quickly as possible.

2. More than six months had passed since some of the providers had been hired.

3. Hospital system clinics needed help with enrollment to be able to release claims on hold that significantly impacted its revenue.

SOLUTION

symplr began process that focused on enrolling providers as soon as possible and fixing the existing enrollment problems thus being able to help the billing department file and get paid for claims on hold.

BENEFITS

In just 11 weeks, the hospital system was able to release and collect on more than $1.55 million of claims being held due to enrollment issues, which rose to more than $2 million after 14 weeks.

 


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