Customer Story | Jan 2025
How One Health System Achieved an 83% Drop
Customer profile:
Reduce revenue loss with faster, cleaner enrollment.
Cut losses from $15K/month to $15K over six months.
Lower labor costs and eliminate enrollment overhead.
Standardize timelines and speed provider productivity.
A New England-based healthcare system faced significant challenges with its in-house provider enrollment process. The system was slow, lacked transparency, and resulted in substantial revenue loss from claim denials and delayed provider productivity. By partnering with symplr for Payer Enrollment Services, the organization reduced enrollment time and cut enrollment-related denials by 83%, while also significantly lowering FTE-labor costs. This strategic move not only resolved long-standing operational inefficiencies but also unlocked new revenue streams and provided the financial risk mitigation the organization needed.
The health system’s provider enrollment was managed by an internal team of six full-time employees. The existing process faced challenges such as timeliness, communication gaps between departments, and reliance on outdated software. These factors presented an opportunity for the organization to streamline operations and reduce financial strain.
A senior finance leader at the health system explained, “The FTEs didn’t have the tools or systems to work seamlessly with the medical staff offices. This sometimes led to inefficiencies and delays.”
The lack of an efficient system created a “black box” environment that made tracking enrollment status difficult. This operational bottleneck had a direct impact on the bottom line. Newly hired physicians were often waiting long periods to be enrolled with payers, delaying their ability to see patients and generate revenue.
supported across enrollment
The health system needed a specialized, scalable solution to fix its provider enrollment challenges. The organization selected symplr CVO’s Payer Enrollment Services to overhaul its entire process. The goal was to outsource the function to a team of experts who could provide efficiency, transparency, and scalability.
The finance leader, a proponent of strategic outsourcing, saw the value in leveraging a CVO partner with deep expertise. “I want to hire specialists that have scale, that have reliability, that can provide higher quality without the risk of a single point of failure,” he explains.
The implementation of symplr’s Payer Enrollment Services provided the organization with a systematized and trackable workflow. The new process not only addressed the core enrollment for its 500-600 providers but also expanded their capabilities. For instance, the previously onerous process of enrolling with various state Medicaid programs became manageable, unlocking a new revenue stream. “Now if we need an enrollment, we get an enrollment regardless of what state it is, so that is certainly an upside to the process and a real value add,” the finance leader states.
The shift to an outsourced model delivered clear, quantifiable results across the board. The health system saw significant improvements in speed, revenue, and operational efficiency.
Accelerated provider enrollment
Provider enrollment timelines became much more predictable and consistent, landing between 90 and 120 days for nearly every provider.
Drastic reduction in denials
The financial impact was immediate. For example, at one of its hospitals, the organization was losing $15,000 per month due to enrollment-related denials. That number dropped to just $15,000 over a six-month period—an 83% reduction.
Significant cost savings
By outsourcing the function, the organization reduced its FTE-labor costs, saving the organization hundreds of thousands of dollars annually in overhead alone.
Improved internal focus
With the provider enrollment process running smoothly in the background, the finance leader and team can focus on other strategic priorities. “I no longer need to spend time escalating things daily, weekly, monthly,” he says.
Better transparency and reporting
The “black box” of the old system was replaced with clear, accessible data.
Enhanced operational stability
The partnership provides the support and scale that an in-house provider enrollment team could not. “Hire a company that has several hundred people doing this that can make sure you’re covered if someone leaves or quits,” the finance leader advises. “It’s that specialization and redundancy that’s really valuable from a financial and risk mitigation perspective.”
Conclusion
For the health system, the decision to outsource provider enrollment to a CVO was a strategic success, which the finance leader attributes to the collaborative relationship with symplr. “Whoever you’re outsourcing to has to be open, communicative, and engaged,” he explains. “I treat the outsourced function and the people doing the service really as my own staff.”
By choosing a trusted CVO partner with deep expertise and a commitment to communication, the organization transformed a problematic and costly internal process into a streamlined, efficient, and revenue-driving operation.
See how symplr’s NCQA-certified Credentials Verification Organization delivers complete, accurate provider files the first time, so credentialing and enrollment stay on track.
Expert Staff
Years Experience
Ranked CVO
