For any healthcare organization, payor enrollment is essential to a healthy revenue cycle. But with so many rules and regulations in place, it can be challenging to navigate the payor enrollment process and get providers enrolled in a timely manner. Understanding important elements of the process will help set you on the right course toward profitability.

If you are new to payor enrollment, these six tips will help you navigate the process and help you get your providers enrolled with payors as soon as possible.

  1. While bringing on new providers is exciting, implementing payor enrollment is an involved process. Understanding the requirements of commercial payors as well as government payors gives you an advantage when you’re implementing payor enrollment. Learning these requirements and continually monitoring their process changes helps you stay up to date and keeps your enrollment efforts sailing forward.
  2. Enrolling a provider with commercial payors is done by completing and submitting a detailed application and contract to each payor. Applications vary widely among the health plans, with some using an online process. All require thorough and extensive paperwork up front to ensure accurate, complete applications and supporting documentation. Start to compile the information needed by requesting data from your providers in advance.
  3. Provider credentialing is another important aspect of payor enrollment. Be prepared to work with credentialing staff to manage the process of verifying a provider’s background for each payor. Keep the lines of communication open with providers if you have a question or need more information.
  4. Enrolling in the government health plans Medicare and Medicaid requires different applications, and each plan has different application requirements. As Medicaid is state controlled, the process varies by state. Some states use an online process. Find out more about government plans’ requirements here: https://www.cms.gov/medicare/provider-enrollment-and-certification/medicareprovidersupenroll/enrollmentapplications.html.
  5. Commercial and government health plans determine effective dates differently and it helps to understand this in planning. Medicare will give an effective date of 30 days prior to the receipt of an application if explicitly requested, but Medicaid may have a different way of setting the effective date depending on the state overseeing the plan. Keeping track of a provider’s effective date for each plan is key, since the date will determine when a provider can start to receive reimbursements and ultimately impacts your bottom line.
  6. The payor enrollment process can be lengthy; therefore, time is of the essence! Start your process as soon as you hire a new provider. Many commercial payors take three months or more to process and approve an application. Since processing times vary by payor, you will want to contact each plan and ask about its typical timeframe for processing an application.

Understanding the requirements for health plan enrollment will help you plan your course and move past obstacles in your payor enrollment process. Credentialing software can help streamline your payor enrollment and manage important documents. If leveraging additional resources is an option, you may choose to enhance your payor enrollment efficiency by outsourcing the process to specialists. To learn more about navigating the enrollment process and how outsourcing can benefit you, review the symplr white paper, Navigating the Payor Enrollment Process.

To learn more about navigating the payor enrollment process and how outsourcing enrollment services can benefit your organization, visit the symplr white paper, Navigating the Payor Enrollment Process.Payor Enrollment from symplr

We offer complete client support to help you navigate the complexity of provider enrollment, saving you time and money. Learn more about Payor Enrollment Services at www.symplr.com/products/payor-enrollment-services or schedule a demo at sales@symplr.com.

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