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 Sometimes it’s outdated forms.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.
If you want to avoid common pitfalls and get payor applications completed as fast as possible, then you want to get strategic with your game. Take these tips from some of our favorite childhood games and start thinking of the payor enrollment process as a game you’re sure to win.
Sort your cards and get ready to play
Just like a game of cards, the first thing you’ll want to do is sort your payor enrollment applications and information according to suit - that is, the type of payor you are applying to. Payor enrollment applications come in three suits: government-run health plans, commercially-run health plans, and workers’ compensation. They might look similar on the surface, but watch out! Each suit has distinct rules, norms and forms. Organize your enrollment processes around the three types of payors so you can stay alert to their nuances throughout the game play.
Make sure you play by the rules
Sometimes, we skip ‘em. Then a few rolls into Monopoly, you realize your opponent’s sophisticated knowledge of miniature empire-building has all the Railroads on her side of the board and you’re on the verge of bankruptcy! Don’t let details derail you. Brush up on payor applications regularly. Visit the websites of the payors preferred by your health system or group. Access the latest applications and instructions. Read them and understand what is being asked of your providers. If you haven’t already, confirm you know all of the popular payors in your area. Get this info from the Atlantic Information System Directory of US Health Plans, referring providers, and your local hospital business office.
Ask strategic questions to get ahead
In guessing games like Twenty Questions, winning is easy if you ask a few strategic questions at the start of play. Experts in payor enrollment tell us to ask these eight questions of payors. Questions range from the mundane details of paperwork to strategic insights into fees and time. Getting in front of these questions now will prevent delays and costly barriers down the road.
Attach the evidence
It’s not enough, in the game of Clue, to know whodunnit. You have to drag the weapon and culprit to the scene of the crime before declaring the case solved. Let this be a reminder to you to drag all the evidence of your providers suitability to perform to the enrollment application. Different applications have different attachment requirements, but they tend to include the provider’s pre-application, CAQH profile, info from the NPI registry and credentialing evidence. Some payors ask for a lot of proof!
Plan for delays
You know you’ll need more time to think when your Scrabble tiles say ZFWEGDS. Some puzzles in payor enrollment are just as confounding and time consuming. Be aware of common bottlenecks and plan what you’ll do when payors’ actions stall your progress.
Three areas where the payors drag are in electronic credentialing, prompt decisions and notification, and process transparency. You need to be on the lookout for when a determination has been made. Follow up with the payor and respond quickly to all information requests. You know you’ve won when you have the acceptance letter and welcome letter in your provider’s record.
When winning is everything, get the cheat codes. For the gamers out there, you know what I’m talking about. The fastest way to win is to use the cheat codes. When it comes to payor enrollment, that means partnering with symplr to get your providers billable twice as fast. symplr payor enrollment services sets you up with a team of experts who know all the ins and outs.
symplr’s suite of web-based provider management solutions delivers an easy and effective way to manage the lifecycle of your providers, from initial appointment provider credentialing software to privileging and provider enrollment, to peer review and incident reporting.
You can learn more about the payor enrollment process by watching this webinar on how to set up your own checklist for payor enrollment success. You can also download our whitepaper on Top 10 Payor Enrollment Mistakes to Avoid.