Solutions To Speed Up the Insurance Provider Enrollment Process

Healthcare credentialers are under constant pressure to complete insurance provider enrollment as fast as possible – the organization’s revenue is dependent on it. Healthcare organizations lose up to $9,000 per day when a provider isn’t seeing patients, making even a week-long delay very costly.

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 the process through which healthcare providers apply to be included in a health insurance plan’s network. Once enrolled and approved, the provider becomes “in-network” and can bill the insurer for covered services delivered to plan members. The process includes three distinct phases:

Contracting

Process in which healthcare providers negotiate agreements with payers – such as insurance companies – and agree upon terms related to reimbursement for services. Contracting and credentialing should happen simultaneously to pave the way for seamless insurance provider enrollment.

Credentialing

Process in which a provider’s education, training, and knowledge are verified to ensure they’re qualified to be credentialed with insurance companies. This is not only for patient safety, but is also critical for maintaining regulatory compliance and minimizing liability risks.

Enrollment

Insurance provider enrollment is the application process for payers to determine whether providers meet their organizational standards to deliver services to members. All of the information verified during the credentialing process is submitted, along with additional documents required by each payer. Once enrolled, providers can bill payers and receive reimbursement for services rendered to subscribers.

Examples of commercial insurance:

Examples of Government insurance:

Medicare provider enrollment
Medicaid provider enrollment

Five Ways To Speed up Insurance Provider Enrollment With Credentialing Software

Insurance provider enrollment is a lengthy process, taking 60 to 120 days on average. If organizations are losing $9,000 per day, per provider, and insurance provider enrollment takes the full 120 days (instead of 60), the organization has lost $360,000. Yikes.

While much of the enrollment process is spent waiting – waiting for providers to submit documents and waiting for payers to review the application and respond – technology can help. Here are five are ways that provider enrollment software software streamlines the process so providers can start earning.

1. Simplify Document Collection

When you make it easy for licensed clinicians to submit documents, you’re likely to get them back more quickly. Look for credentialing software that enables providers to upload documents on their own – in bulk – without having to log in or jump through other hoops. In addition to electronic document requests, MedTrainer also offers AI Upload Assistant, which enables credentialers can upload any number of documents for any provider and AI will classify the document type and associate it to the correct provider. This dramatically reduces the amount of time credentialing teams spend on provider document management, and increases accuracy.

2. Follow a Standard Process

On average, there are 30+ documents required as part of every insurance provider enrollment application. But, every insurance payer has a least a few that are different, so it’s not as simple as just duplicating enrollment packets. By creating a standardized process for each payer, you can ensure you’re submitting exactly what is needed so the application isn’t rejected or denied. Look for the ability to set required documents per payer in your credentialing platform. MedTrainer even offers automated credentialing packet generation – using the required documents you set and compiling everything into a single PDF.

If you don’t have software yet, download this Enrollment Application Checklist.

3. Ensure Visibility

It’s very difficult to optimize or streamline insurance provider enrollment if you don’t have visibility into the current process – which is common when using spreadsheets, paper, or outdated systems. Enhanced credentialing reporting offers real-time enrollment status, progress, and insight to areas that are slowing down the process. Using this transparency, you can tweak the process or better train individual team members to get the best results. Below are six data points to capture:

4. 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 available in software that can improve enrollment:

Exclusions Monitoring: It’s nearly impossible to check exclusions on the 30-day NCQA-compliant schedule unless you have an automated solution.
License Verification: Automated license verification software accesses original sources on demand, pulling a provider’s most recent license information and image right into the platform for credentialers to verify.
Expiration Reminders: Both providers and credentialers can get email reminders starting 180 days from document expiration to avoid missing a vital deadline.

5. Leverage Group Enrollments

For organizations who enroll many providers under the same business entity tax ID number, group enrollment functionality in credentialing software can save a ton of time. Once provider credentialing is complete, all you have to do is customize a provider roster and schedule it for a monthly send to each payer. This dramatically reduces the time needed per enrollment, so the credentialing team can focus on higher priority tasks and problem solving.

Expedite Insurance Provider Enrollment With MedTrainer

MedTrainer Credentialing Software keeps all the necessary information for insurance provider enrollment software 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 credentialing tracking and reporting 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.

Ready to speed up your insurance provider enrollment process with software? Schedule a demo to see MedTrainer Credentialing Software in action.

Solutions To Speed Up Insurance Provider Enrollment

Get the tools you need to eliminate delays in your provider enrollment process.