Provider Enrollment Services help healthcare organizations simplify the complicated process of credentialing providers and enrolling them in Provider networks.
Provider enrollment refers to a provider becoming a member of a network for health insurance plans. This involves requesting to be included in a payer network, filling out credentialing requirements, and submitting documents.
To receive payment for the provision of care, healthcare organizations must ensure that Provider enrollment for all providers is complete. Providers will not reimburse healthcare organizations for services provided by providers not part of a plan’s network.
Failure to complete the Provider enrollment process within a reasonable time frame will increase on-hold claims and, in some cases, claim denials which can be a huge risk.
However, enrollment of Providers is a lengthy and complicated process for many healthcare organizations. This is why it is becoming more critical to streamline the process and make it more accessible as providers compete in a highly competitive market.
Healthcare organizations are experiencing a change in their provider workforce, making it difficult for medical service staff to keep up with the changes. As more claims are filed, it could lead to a drop in revenue for the company.
Outsourcing Provider enrollment services to third party service providers can be an excellent option for busy medical staff and patient financial specialists. Organizations can streamline the process and manage various Provider requirements and procedures. They also keep track of expired enrollments and credentials which is a plus point.
Streamlining Provider Enrollment For Time And Money
Enrolling as a Provider is a complicated process that can take several months.
The average time for a Provider to credential a provider is between 90 to 120 days on average. This means that the whole enrollment process can take several months. Even smaller plans may require more time to process provider enrollment.
Healthcare organizations can compound the problem by failing to gather all necessary documents to credential and engaging in duplicate efforts to enroll Providers. Organizations are more likely to experience delays in claims reimbursement and possibly increased denials.
Healthcare organizations can outsource Provider enrollment to third parties to help them streamline provider credentialing and plan participation.
These services help collect documents necessary for registration and credentialing, as well as tracking responses from Providers to requests for provider participation.
Providers can begin seeing patients and billing for services faster with a simplified Provider enrollment process.
Healthcare organizations can work with many Providers simultaneously. Their providers must be enrolled with each company to receive timely reimbursement.
Private and public Providers have their enrollment processes. When enrolling in a plan, medical services staff must be familiar with the rules and requirements of each Provider.
Navigating the complex web of Provider enrollment rules can slow down the process for a healthcare provider, leading to an increase in on-hold claims.
Healthcare organizations can use a third party service providers to help them navigate Provider requirements and rules. To better understand each Provider’s unique regulations and forms, Provider enrollment service vendors should meet with each healthcare organization to discuss how they add providers to their network.
Staying On Top Of Re-Enrollment
The Provider enrollment process for each provider within a healthcare organization is not completed. Provider enrollment is an ongoing process for every provider.
Providers must verify or re-enroll their credentials every two years to ensure those network providers can still provide high-quality care. The Affordable Care Act requires Medicare provider validation every five years.
If providers fail to re-enroll or validate their claims by a deadline, healthcare organizations will have their claims placed on hold and their billing rights revoked.
If organizations fail to update provider data frequently and monitor the expiration of certificates or documentation, they will face claims delays and denials.
It can be time-consuming and error-prone to track when certificates and enrollment expire for each providers. An outsourced Provider enrollment service monitors documentation and enrollment expirations.
Outsourcing Provider enrollment services facilitate communication between providers, Providers, healthcare organizations, and Providers. The outsourcing process facilitates communication among the three parties to ensure that enrollment is approved and remains approved.
Healthcare organizations will see more claims paid on-time and without complications if there is an easier way to enroll Providers.
For a practice to thrive, it must be able to enroll providers in their health plans on time. eClaim Solution’s Provider enrollment services will help you to reduce paperwork, simplify the provider onboarding process, and increase the profitability of your healthcare organization. Healthcare organizations can use our Provider enrollment services to make it easier.
We also offer different services other than provider enrollments, which includes;
