RCM Depends on Efficient and Transparent Enrollments
Provider Enrollment should not come as an afterthought
With an efficient provider onboarding process, interdepartmental communication includes the key team members of recruitment, administration, provider onboarding, credentialing, scheduling and billing & coding. When these teams have clear timeframes and systems in place, there is appropriate time allocation for the provider to return the intake packet and supporting documents which is then reviewed and moved onto an assigned credentialing or provider enrollment specialist.
If recruitment and scheduling decide to start a provider within two weeks of accepting the offer, they run a significant risk of the provider starting to see patients while out of network with major insurance networks. Even with temporary hospital privileges, there will be a catch up period that can drastically impact revenue due to holding claims.
What are some of the top reasons for credentialing and enrollment delays?
- Incomplete onboarding packets - missing or invalid license information, missing copies of diplomas and board certifications, incomplete or expired CAQH profile
- Missing state license - If a provider is new to the state, they must have a license or temporary license issued to begin enrollments
- Malpractice coverage - Administration needs to submit requests for malpractice coverage as soon as possible to insure that a valid certificate of insurance (COI) is available to upload into CAQH and submit along with all enrollments. Without a current COI, credentialing becomes a stand still.
- Malpractice claims history, sanctions or other disciplinary actions
- Supervising physicians for midlevel providers
- Familiarize yourself with your state's scope of practice or supervising requirements by specialty.
- Hospital privileges or admitting arrangement
- Missing signatures or missing attachments.
- While most networks have adopted digital/electronic application submission there are some that will still require a wet ink "original" signature and hard copy mailed application. We recommend using an internal checklist and application workflow to ensure that all signatures and submissions are complete.
- Typos or incorrect application types
- Yes this does happen, because as humans typos can occur! An efficient credentialing process includes a quality assurance workflow to catch errors before applications are submitted. Always double check when choosing the specialty, place of service, and enrollment type!
- Outdated credentialing forms
- This is somewhat at the discretion of the payer because they may accept an older application form when they have recently updated their credentialing packet. Otherwise they may reject the application and require a new submission.
If your team is feeling burned out by barely surviving a 90-120 turnaround time and the pressures of daily emails from the billing team wondering if they can release claims.. we promise there is a better way.
Automating intake and providing transparency to all stakeholders throughout the process is absolutely paramount to the success of Revenue Cycle Management!
