Conquering The Provider Enrollment Process

The average healthcare organization counts on ~$2.3M in annual revenue from each provider – or about $9,000 a day. Any delay in the provider enrollment process means less revenue for the organization – and the longer the holdup, the harder the hit.

Enrollment delays cost nearly a third of organizations polled in a 2023 MedTrainer survey money, and 26% believe credentialing delays increase compliance risks that can significantly drain coffers. That makes expediting the provider enrollment process a critical strategy for any healthcare organization.

How much are enrollment delays costing your organization? Download our Credentialing Reality Worksheet to find out!

You can’t control what happens on the payer side of the enrollment process. However, there are ways to leverage enrollment checklists and technology to ensure everything you need for a smooth application process happens the first time.

Step-By-Step Provider Enrollment Process

There are many reasons provider enrollments are delayed: incorrect information, missing documents, busy credentialers, and slow-moving payers. Checklists are powerful tools to kickstart enrollments and get revenue rolling in quickly.

A provider enrollment process checklist organizes tasks to complete the enrollment application. It ensures you always know the next step and where you are.

Enrollment Application Checklist

• Gather Training and Education
  • Practitioner degree (MD, DO, DPM), post-graduate education or training
  • Medical or professional education/training details
  • Designated specialty residency completion
• Gather Licensing and Certification
  • Current license/certification in the state(s) where provider will be practicing
    • No temporary licenses
  • National Provider Identification (NPI) number
  • Specialty
    • Surgeons needs board certification, RNs don’t need anything else
  • Active DEA number and/or Controlled Dangerous Substance (CDS)
  • Certificate or acceptable substitute (if required)
  • Medicare/Medicaid participation eligibility or certification (if applicable)
• Gather Work History Details
  • Five-year work history. Explain any gaps longer than six months
  • Statement of work limitations, license history, and sanctions
    • Only required if you are applying to join UnitedHealthcare’s Medicare and Medicaid plans
  • W-9 form
  • Hospital staff privileges
• Gather Payer-Specific Requirements
  • Active errors/omissions (malpractice) insurance or state-approved alternative
  • Malpractice history
  • Special needs survey
  • Letter of intent
  • Disclosure of ownership statement
  • AMA profile or criminal history review as required by credentialing authorities
  • Notification if provider has ever been a delegated provider before this application
  • Complete credentialing application in portal
• Following Application Submission
  • Check application at week one
  • Check application at week two
  • Obtain credentialing approval via portal

Download a copy of this provider enrollment checklist, plus a bonus post-decision checklist by downloading Tools To Conquer Provider Enrollment.

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

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Credentialing Software Drives Speedy Provider Enrollments

Credentialing software offers several benefits that help credentialers speed up the provider enrollment process.

Data To Improve Processes

With all credentialing data in one place, you can quickly assess and improve your enrollment process. Choose software 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

Credentialers can spend less time tracking and more time working directly with payers and providers when reporting is customizable and automated. Save your favorite reports for easy access, and schedule them to be emailed to internal and external recipients so you — and leadership — are always up-to-date on progress and can quickly identify issues.

CAQH Profile Management

Streamline your enrollment processes with the most up-to-date provider information at your fingertips. Save time and improve provider onboarding and recredentialing with CAQH profile management.

Actionable Enrollment Workflows

Simplify enrollment processing with a customized workflow, including a process checklist with embedded notes and task assignments. Easily assign multiple enrollments to staff, update statuses, and prioritize.

Take the Next Step To Improve Your Provider Enrollment Process

Download Tools to Conquer Provider Enrollment, an in-depth guide with valuable tips on speeding up the time from credentialing to enrollment approval. You’ll find the Enrollment Application Checklist and a Post-Payer Decision Checklist with steps to follow for approvals, denials, and rejections.

Want more? Schedule your demo to see MedTrainer Credentialing Software in action.