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Provider Enrollment and Its Importance

Although proper enrollment with payers may not be the first thing on a provider’s mind, its importance should not be underestimated.  It is a meticulous process which requires absolute accuracy and timeliness.  Without it, providers cannot hope to be reimbursed for their services.  The accuracy and time constraints involved in this process can make it seem challenging and difficult, especially if you’re uncertain of all the requirements.  However, an excellent provider enrollment specialist can streamline the process and walk the provider through it effectively and with less stress.

 

Provider Enrollment is an essential process for all provider types to ensure they are compensated appropriately for services rendered.  All governmental payers as well as some commercial payers require that providers be properly enrolled prior to filing claims for reimbursement.  Some of the documents which may be required include, but are not limited to: NPI number, CV, malpractice insurance certificate, licensure and certification.

 

The most important aspect of the enrollment process is submitting the enrollment application in a timely manner.  Claims for services rendered to patients whose insurance requires enrollment will not be processed or reimbursed until the enrollment process is completed.  Submitting enrollment applications in a timely manner is imperative to maintaining a steady cash flow for your practice.

 

Provider enrollment can be quite a lengthy process.  Most payers request that you allow up to 90 days, if not more, for applications to be processed.  This is one of the reasons extreme attention to detail is so essential.  If a mistake is made in the application, it can take up to 30 days for a correction to be processed, or the entire application could be rejected,which would result in starting the process over from the beginning, potentially losing the requested effective date and could lead to delays of up to 60-90 days for the new application to complete processing.   

 

In addition to submitting the application fully and accurately, it is also very important to have consistent follow up with payers you are enrolling with.  We recommend regular intervals of follow up with the payer.  This allows for the provider enrollment specialist to become aware of any issues or additional information which may be needed to complete the process.

 

Whether it is starting a new practice or adding a new provider to an existing group, it is important to begin early, ensure you have all the required documentation, and make sure all applications are completely accurate.  Using a practice management company with a well-educated, experienced, provider enrollment specialist, will help make the process smoother, and take the worry and stress out of enrollment for the provider.   He or she can assist the provider through the entire enrollment process with ease

 

 

By: Kelli Smith

Provider Enrollment Manager

On Thursday, October 11, 2018

Categories: Compliance & Coding News

The information presented herein reflects general information that is current as of the date it was first published. Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.

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