Healthcare credentialers are under constant pressure as insurance provider enrollment kicks into high gear. They must navigate unique requirements for each payer while constantly communicating with providers to ensure the proper documents and information are available so costly enrollment delays don’t occur.

This blog will highlight how healthcare organizations can speed up the enrollment process and reduce some of the pressure on credentialers as they navigate insurance provider enrollment.

What Is Insurance Provider Enrollment?

Insurance provider enrollment is crucial for healthcare providers to offer reimbursable services within the payer networks. The process includes three important steps before providers can be reimbursed:

Contracting

Process in which healthcare providers negotiate agreements with payers–such as insurance companies–and agree upon terms related to reimbursement for services.

Credentialing

Process in which payers verify the qualifications of healthcare providers to ensure they meet organizational standards to deliver services to subscribers.

Enrollment

A process by which healthcare providers are approved for in-network service with payers. This allows providers to bill payers and receive reimbursement for services rendered to subscribers.

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Three Steps To Speed up Insurance Provider Enrollment

Credentialers can only work so fast on the tasks they control. They request documents and information from providers but may wait days for a response. More frustrating is the waiting game played with payers. Credentialers can’t dictate how fast an insurance company enrolls its providers, which can take weeks or months.

But there are ways to streamline enrollments so providers can start earning.

Leverage Data

The first step is to use what you already have: data. Information about past enrollments can show how to speed up the application process and shorten delays. Below are six data points to capture:

Embrace Automation

Automation won’t eliminate credentialer involvement in the insurance provider enrollment process, but it can reduce what’s on their task list. Here are three of the many automation features that can improve enrollment:

• Document Collection: Electronically request provider documents via a secure online upload with automated reminders until the provider uploads all required documents.
• License Verification: Automated license verification software now pulls the newest version right into the platform so credentialers aren’t required to log in, download, and re-upload each document. They just need to verify the correct document and it’s data.
• Expiration Reminders: Both providers and credentialers can get email reminders starting 180 days from document expiration to avoid missing a vital deadline.

Use Checklists

On average, enrolling a single provider with one payer takes 4-8 hours of uninterrupted time. Now consider that each provider has 30 documents, and it’s clear that manually tracking each step in the insurance enrollment process is tough.

Following checklists ensures your credentialers won’t miss a document or step in the enrollment process that may cause delays.

Download our Enrollment Application Checklist to reduce the pressure on your credentialers.

Expedite Enrollments With Credentialing Software

MedTrainer Credentialing Software keeps all the necessary information for insurance provider enrollment in one user-friendly place with proven workflows, customizable dashboards, one-click reporting, and automated reminders to keep tasks on track.

Our software offers:

• Enrollment Applications Dashboard: Quickly assess and improve your enrollment process with dynamic graphs that show application age, average time to complete applications, and number of closed applications per credentialer. 
• Built-in Automation: Keep the enrollment process moving forward with automated reminders for providers to send documents, notification of recredentialing deadlines, and license expiration. 
• Highly Customizable Reports: With all credentialing data in one place, it is easy to customize reports for monthly payer submissions so that you can stay on top of due dates and status. Save reports for easy access, and schedule them to be emailed to internal and external recipients. 
• CAQH Profile Management: Streamline your enrollment processes with the most up-to-date provider information at your fingertips. With CAQH profile management, you can save time and improve provider onboarding and recredentialing. 
• Application Workflow Management: Simplify enrollment processing with a customized workflow, status, process checklist, notes, and task assignments. Easily assign multiple enrollments to staff, update statuses, and prioritize. 

Download our guide – Tools to Conquer Provider Enrollment – for valuable tips on speeding up the time from credentialing to enrollment approval. Then, schedule your demo to see MedTrainer Credentialing Software in action.