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.

Arizona’s new law addresses process issues that delay a doctor’s ability to see patients and a patient’s ability to find in-network providers. The new law recognizes three areas where insurance carriers typically drag: electronic credentialing, prompt decisions and notifications, and process transparency. It requires that payors find ways to trim their three-to-six-month process down to 60 business days.

The law is welcome news as we enter our busy season of helping new doctors start their medical careers. As Payor Enrollment experts, we help our clients overcome the inconsistent rules and bureaucratic delays of credentialing. Delays are common because credentialing requirements vary from state-to-state and, sometimes, payor-to-payor within the same jurisdiction.

Under Arizona’s new law, providers will learn sooner if they have been approved for in-network status and, therefore, whether they will be reimbursed for services covered.

It’s a case of "time is money." When a hospital hires a new doctor right out of medical school, they start the doctor seeing patients right away. They pay the doctor for several months before the insurance plans reimburse them for those services. Inefficient credentialing means a doctor will likely begin seeing patients before they find out if they will be paid for their services.

Arizona’s new law provides clarity on a problem that many of our clients face: when to let new providers start working. While it does not require payors to agree on the standards for credentialing doctors, Arizona health insurers will have to publish information about how applications will be reviewed and approved. Also included are new rules requiring faster decisions and more prompt notifications.

As 30-year industry veterans, symplr’s Payor Enrollment Services team has enrolled providers with payers in all 50 states. We are enthusiastic about similar bills, like one recently enacted in Texas and one pending in Louisiana, that also address faster timelines for provider credentialing. Hopefully, these are just the beginning of improved Payor Enrollment regulations across the U.S.

Every effort to shorten the timeline to reimbursements is welcome. We advise our clients to start early, at least 90 days before the hire date, because we don’t have a lot of transparency into whether or when the doctor will get approved. Establishing a practice before the application is approved is an act of good faith. The sooner our providers get a decision from a payer, the better it is for both parties.

 

Providers wondering how they might prepare for the enrollment process should download symplr’s white paper Top 10 Payor Enrollment Mistakes and heed our advice: start early and respond quickly to all messages from a payer. Every day you shave off the enrollment and credentialing process is another day of client reimbursements for your practice.

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