Simplifying Provider Enrollment: FAQs
Here at symplr, we get a lot of questions about payor, or provider, enrollment – and for good reason! Although payor enrollment can be complicated, it’s an absolute necessity for healthcare providers. Read on to see if we’ve answered your questions, and to learn how symplr can help.
What is provider enrollment?
Payor enrollment is the process of applying to health insurance plans and networks to be included in their provider panels. Successful enrollment lets your medical facility or healthcare providers bill insurance companies and health plans for services for their members. Getting providers quickly and correctly enrolled with health plan payors is an essential part of a healthcare business.
That sounds easy enough! What could go wrong?
You might be surprised at how frustrating, time-consuming, and difficult this endeavor can get! Enrollment with federal and state programs (such as Medicare and Medicaid) requires specific documents that can be different from commercial plans. In addition, various states have their own requirements for enrollment. Every plan is different so you need someone who is experienced in this area to organize your enrollment.
Yikes. How is my staff supposed to handle all that?
Unraveling this mess of forms can be confusing and labor-intensive for your administrative staff. Each payor must be contacted individually to review their process, get the required forms, determine the method of submission and time frame for approval, and identify your key contacts. When you throw in tracking simultaneous applications and monitoring for follow-up, initial approval, and periodical re-certification, doing payor enrollment in-house is a monumental undertaking.
Um. Well. Is there any way to make it easier?
We’re glad you asked! The right credentialing software can help automate the application process, by tracking, auto-populating, and even downloading and submitting some applications digitally. As long as your information is up-to-date, you can save significant time and energy maintaining your provider files. A streamlined process for provider enrollment is critical when it comes to protecting and growing your revenue.
That actually does sound easy. But where do I start?
Start with symplr’s Payor Enrollment Services. We understand the challenges of provider enrollment – and we help you navigate the chaos. First, we’ll gather and record your relevant data and information in our system. At the same time, we begin securing and completing the forms required by each individual payor.
When you partner with symplr, we remove the burden of payor enrollment from the shoulders of your administrative staff and turn it over to our team of experts. Our team handles your provider enrollment quickly and easily, helping you avoid application errors, omissions, and delays. In the end, we’ll complete this cumbersome process for you in a fraction of the usual time.
Wow! But what if I still need help after enrollment?
At symplr, we constantly monitor the payors to make sure your applications are received and processed correctly. We also follow up with payors bi-weekly to check for any additional or updated requirements, and to identify and resolve potential issues before they even start. This can greatly reduce both delays in processing and outstanding AR. We also handle re-credentialing, and can help you address any needs arising from changes in circumstance - such as relocation or acquisition of your healthcare facility.
Sounds great! Where do I sign up?
If you are ready to increase your efficiency and reduce AR days by streamlining your payor enrollment, contact our experts at symplr today! We can help assess your procedures and identify problem areas to come up with a solution that lets your staff breathe easy, and improves your bottom line.
About 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.