Is Payer Enrollment The First Step?

WWS assist healthcare organizations in deciphering the complicated process of credentialing providers and enrolling them in payer networks.

Payer enrollment is the process by which a provider joins the network of a health insurance plan. Requesting participation in a payer network, completing credentialing requirements, submitting documents to the payer, and signing a contract are all part of the process.

Failing to complete the payer enrollment process on time will result in an increase in on-hold claims — and, in some cases, claim denials.

However, for most healthcare organizations, completing payer enrollment is a time-consuming and complex process, and the need to streamline and improve the process is growing as providers face an increasingly competitive marketplace.

Enhancing PAYER ENROLLMENT TO SAVE TIME AND MONEY

Payer enrollment is a time-consuming process that can take several months to complete.

Payers typically require 90 to 120 days to complete provider credentialing alone, resulting in an average enrollment process of months. Smaller plans with fewer resources may require even more time to process provider enrollment.

Healthcare organizations can exacerbate the situation by failing to collect all required documents for credentialing and engaging in redundant efforts to complete payer enrollment. As a result, when workflow inefficiencies add time to an already lengthy process, organizations are likely to face claims reimbursement delays (and possibly an increase in denials).

 NAVIGATING PAYER REQUIREMENTS AND RULES

Healthcare organizations work with dozens of payers at the same time, and their providers must be enrolled with each insurance company in order to receive timely reimbursement.

However, neither private nor public payers have a standardized process for enrolling new members. When it comes to plan enrollment, medical services staff must understand each payer’s rules and requirements.

Humana, for example, requires providers to use CAQH Proview, a service provided by the Council for Affordable Quality Care (CAQH), to submit credentialing information. Additionally, providers must have a Drug Enforcement Agency and/or Controlled Dangerous Substances certificate.

Aetna, on the other hand, requires providers to use the CAQH Proview platform. However, the payer also evaluates provider credentials using quality standards established by the National Committee for Quality Assurance (NCQA).

KEEPING UP WITH REENROLLMENT

Despite enrolling every provider in a healthcare organization in the appropriate payer networks, the payer enrollment process is incomplete. Payer enrollment is, in fact, a continuous process for each provider.

Payers require network providers to re-enroll or verify their credentials every couple of years to ensure they are still eligible to provide high-quality care. The Affordable Care Act, for example, required Medicare provider revalidation every five years.

It takes time and is prone to error to keep track of when each provider’s enrollment and certificates expire. A payer enrollment service, on the other hand, specifically monitors enrollment and documentation expirations.

A payer enrollment service also updates provider data on required platforms, such as CAQH’s Proview, on a regular basis.

Enrolling providers in health plans on time has become a critical requirement for maintaining a thriving practice. WWS payor enrollment services can help you reduce paperwork, streamline your provider onboarding process, and increase your healthcare organization’s profitability. We make payor enrollment easier for healthcare organizations all over the nation.