healthcare compliance and credentialing

Bringing new providers on board is an exciting, yet complex process with plenty of moving parts. If you’ve ever hired a physician or mid-level provider, you understand how much work the process entails. Payor enrollment is one of the most critical, yet misunderstood pieces of the puzzle. While getting your providers billable sits right on top of the to-do list, completing the process the right way requires more expertise, diligence, and experience than most people assume.

I have been in the payor enrollment industry for 27 years, so people often ask me how the industry has changed. Steadily, I say, with a few punctuations of accelerated change.

It doesn’t take too many trips down the chutes and ladders of payor enrollment checklists to realize there are a lot of unforeseen obstacles in our path. Sometimes it’s outdated forms. Sometimes it’s a missing pre-application to the application. Sometimes it’s bad instructions, and you end up sending the application to the wrong address.

It’s not every day that laws are passed unanimously, but that’s exactly what the Arizona legislature did when it passed HB2322. Requiring healthcare insurers to speed up the process of credentialing new providers into their networks, this bill is a welcome change.

Have you recently hired a healthcare provider to join your practice? Making sure the provider becomes enrolled with commercial and government insurance payors is essential to maintaining a steady patient base and cash flow to your practice. To ensure the enrollment process moves along efficiently and in a timely manner, you will need to submit the provider’s application and required documents as soon as possible to the top payors in your area.

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 on board, enrolled with payors and credentialed by the end of the fiscal year?