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Donna Goestenkors

By: Donna Goestenkors on March 28th, 2016

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5 Payor Enrollment Mistakes to Avoid

Payor Enrollment

No matter the size of your healthcare organization, having an efficient provider enrollment process is essential. Not only is it directly tied to your revenue stream; it also carries significant weight in how the organization utilizes its staffing budget. For some, delays in enrollment can harm the quality of care – especially if the process takes months to a full-year and limits the scope of practice by the provider.

At first glance, payor enrollment seems simple – you just accumulate provider credentials and send the requested documents and forms to the insurance company. However, the process is highly vulnerable to errors that lead to unexpected delays. Here are five common mistakes to avoid to ensure that your payor enrollment moves along efficiently:

Common Mistakes That Lead to Payor Enrollment Delays

  1. Incomplete Applications

For starters, make sure you submit complete information on all forms and documents. Depending on the state, health insurance programs may routinely introduce policy changes that can affect an organization’s enrollment. This is especially common when enrolling out-of-state providers, who may need a referral or additional information for enrollment. Organizations can avoid this mistake with dedicated research to ensure they are using the correct forms and following all submission processes.

  1. Poor Planning

The payor enrollment process is difficult enough to manage without forgetting to factor in the time required for a response from the payor. Health organizations should plan for at least 90 days for the application to reach completion. Depending on the size of a payor’s network, this time allowance may fluctuate at various periods throughout the year.

  1. Neglecting to Follow-Up

The biggest efficiency differentiator is persistent communication. Large payor networks are consistently backlogged and may fail to send status updates, including application mistakes or enrollment acceptance. When a payor denies enrollment, it is likely due to missing credentialing information or a lack of clarity in the submitted forms. Keep in mind that some payors may have alternative approval methods available – all you need to do is ask about them.

You should also embrace the best practice of regularly following-up with your payor networks to ensure that applications are being processed. The best way to make sure applications are on the right track for enrollment is through regular phone calls, emails, and checking online for updates.

  1. Excessive Paperwork

Skip the physical paperwork that requires excessive time to transfer and process. Most payor programs have electronic forms and submission addresses to expedite the process. Where possible, substitute paper forms for electronic forms to reduce errors and time spent forwarding information.

  1. Outdated Forms and Contact Information

Maintaining updated forms and contact information can greatly reduce delays in enrollment. It is best to keep a first or second-degree contact with a payor organization so you are always up-to-date on application changes. For example, having a current contact can give you a leg up in resolving any issues when setting up electronic funds transfer (EFT) or electronic billing (EDI).

Ultimately, you should make investing in efficiency a major priority for your payor enrollment process. At the end of the day, preventing delays and submission errors can have a drastic impact on your financial bottom-line and the quality of care.

Ready to streamline your payor enrollment process with symplr? When you partner with symplr for payor enrollment, you gain access to an entire team of enrollment experts. Clients can expect to cut their enrollment processing times by weeks and even months over their in-house systems. To learn more about Payor Enrollment Services by symplr, Schedule a Demo with us now!

Learn more about streamlining the payor enrollment process with our webcast series, Checklist for Payor Enrollment Success Overview. This webcast is presented by our guest speakers Donna Goestenkors, CPMSM of Team Med Global Consulting, and Dina Solis of Sonoma Credentialing Services. With more than 55 years of experience combined, Donna and Dina are experts in their field.



About Donna Goestenkors

Donna is a full time healthcare consultant, speaker, author, educator, and mentor serving the Medical Staff Services industry for over 40 years. Her diverse project experience includes assignments in every work environment and rapport building among all levels of professional and executive staff. Donna is a past President of NAMSS and her client work covers all of the industry's environments from Healthcare Systems to critical access hospitals.