Simplifying Payer Enrollment Process

November 19, 2015
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Experienced medical staffing professionals know that credentialed Providers cannot generate revenue until they are enrolled with Payers, although payer enrollment can be complicated, it is an absolute necessity for healthcare organizations as it clearly impacts their revenue.

Here at Santech, we get a lot of questions about payer enrollment and we have tried to consolidate few key questions in this article. If you have more questions, feel free to contact us.

Experienced medical staffing professionals know that credentialed Providers cannot generate revenue until they are enrolled with Payers, although payer enrollment can be complicated, it is an absolute necessity for healthcare organizations as it clearly impacts their revenue.

Here at Santech, we get a lot of questions about payer enrollment and we have tried to consolidate few key questions in this article. If you have more questions, feel free to contact us.

What is payer enrollment? 

Payer enrollment involves enrolling a physician or allied health provider with a particular insurance payer in order to receive reimbursement for services rendered. Providers frequently are required to complete lengthy applications long with necessary information that includes education, board certifications, references, hospital privileges and state licensure, etc.

Isn’t this a simple process?

Not really as it looks. Credentialing Coordinators are tasked with collecting supporting documents from providers, cross-checking the information, verifying the authenticity of what is provided, and preparing the file for monthly credentials committee meetings.

Some of the payers accept a unified application proposed by CAQH, others will use applications mandated by their states (such as state of Texas), some payers would have worked out a delegated relationship with your organization that means you need to send out an excel file to the payers in the format you have agreed on.

And the confusion and complexity does not ends here. If you have multiple locations and multiple providers and your business accepts patients with several insurance plans in the area, unknowingly you are sitting on a massive task of identifying payer enrollment need for each new practitioner at each location with each new plan, when you throw in tracking simultaneous applications and monitoring for follow-up, initial approval, and periodical re-certification, doing payer enrollment in-house is a monumental undertaking in itself.

Is there any way to make it easier?

We’re glad you asked! Most credentialing software’s have not understood and solved this problem as they remained focused on only managing and validating the provider file.

Santech went a step ahead and made I-Enroll, It can help automate the payer enrollment process, by tracking, auto-populating, and even downloading and submitting some applications electronically. I-Enroll also hold largest payer forms library.

Even if you are managing your Provider Data in a separate system, I-Enroll can be integrated seamlessly to receive data from these systems of records and help streamline the payor enrollment function.  As long as your provider information is up-to-date, you can save significant time and energy maintaining your provider files. A streamlined process for payor enrollment is critical when it comes to protecting and growing your revenue.

Now that’s simple, how should I get started?

If you are ready to increase your efficiency and by streamlining your payor enrollment, Contact one of our I-Enroll Evangelists today or call us at 732-658-0072 and dial Extension 303. We’ll help you explore the ways I-Enroll can help you increase your revenues, by getting your providers enrolled faster.