Provider enrollment is an inevitable process that comes with running a healthcare business such as a physician practice, rehab clinic, or urgent care center. Becoming a provider with commercial and government insurance companies is essential to maintaining steady patient referrals and cash flow and are the backbone of any successful practice. Avoiding the following common mistakes will ensure your credentialing application and provider enrollment process moves along efficiently and timely.
1. Forgetting to Include Complete Information
During this early application phase, an insurance company needs a thorough picture of your current and past medical practice to determine if you would be a good fit for their provider network. Requested data usually includes practice address, phone, fax, contact information, services provided, copies of your licensure, employment history, average patient profile and any records of past legal troubles regarding your medical practice. Omitting any of this data can lead to delays in your provider credentialing, and it can sometimes be grounds for a denial. Also forgetting to sign the applications and contracts can cause significant delays.
Whether you are compiling this data yourself or working with a provider enrollment and credentialing company, checking your initial application for completeness is essential. Using a provider enrollment and credentialing service will ensure that your information is complete and in the correct format and uncover any areas you may have forgoten about.
2. Starting Too Late
Many practices get started on the provider enrollment process too late, which can be a matter of success and failure for a new start-up practice. In ideal situations, you would want to begin the process at least 90 days prior to opening (with the exception of a provider already joining an existing practice). It should be known that for a new start-up, outsourcing the work to a provider enrollment company, can take at least 4 - 6 months to complete the entire process, doing it on your own could take 8 - 12 months. Many practices simply cannot survive within that time frame.
3. Lack of Follow-Up
As mentioned above, the average provider credentialing process can take months for many practices. Regular contact with the insurer will keep you up to date on your application's status. It can also help to shorten this waiting period in some instances. Many payors are understaffed and the process takes much longer than in the past and being proactive is your best weapon.
Enrolling as a medical provider requires attention to detail and consistent follow-up with an insurer. Working with a provider enrollment and credentialing company can help you complete each phase without unnecessary delays. They can provide you assistance with both government-based and private insurer applications as well as any CAQH and NPI requirements.
If you are seeking assistance with Commercial Insurance or Medicare Provider Enrollment. Please click here for more infomation.
Brian Agnew is President of Supero Healthcare Solutions a leading practice management company focused on provider enrollment and credentialing services for physicians and other healthcare providers.