Medical credentialing and provider enrollment can be the most time-consuming components of your practice’s revenue cycle. Waiting too long to get started or relying on inefficient tools and processes can cause you to miss important deadlines, leading to delays, lost revenue, and scheduling issues. Using these tips will help you stay on top of provider enrollment and credentialing deadlines.
Start as early as possible.
While it can take up to 90 days, beginning at least 150 days before credentialing deadlines will ensure payers have enough time to process applications. As more insurers merge and expand, it’s becoming increasingly difficult to expedite the application process. If your practice is new or planning to enroll with additional payers, you’ll need extra time to negotiate contracts with them.
Keep up with regulations.
Familiarize yourself with your state’s credentialing regulations, including reciprocity laws if physicians are credentialed in other states. The process is less rigorous for providers transferring from one practice to another within the same state. Contact your state’s medical association to make sure you’re adhering to appropriate standards to avoid delays or unnecessary paperwork.
Stay abreast of CAQH requirements.
Most payers use the uniform credentialing program laid out by the Coalition for Affordable Quality Healthcare (CAQH), so keeping up-to-date with this system minimizes physician onboarding and re-credentialing hurdles.
Regularly contact insurers to check application status. Payers usually will not call you to notify you of a problem, so it’s up to you to track applications until they’re approved and provider enrollment has been verified.
Fill out forms completely and accurately.
Eighty-five percent of credentialing applications have missing, incorrect, or outdated information, especially in the areas of work history and current status, malpractice insurance, attestations, and hospital privileges and covering colleagues. Make sure licenses and DEA numbers are current and no fields are left blank. Discrepancies between what a practice has in the system and what an insurer has on file can lead to delays and application denials. Industry experts recommend conducting quarterly payer roster reviews to make sure information is consistent on both sides.
Encourage effective collaboration.
Good communication is critical to avoid credentialing and enrollment snags. Be sure all departments or personnel responsible for the processes are on the same page regarding how tasks should be done and the time frames for accomplishing them. Having standardized procedures in place can help you streamline processes and monitor progress. When implementing a new technology platform, staff and IT professionals should work together to make the transition as smooth as possible. Additionally, talk to your credentialing staff about areas that could be improved. Understanding the impact of delays and lost revenue will motivate your team to optimize workflow efficiency.
Use the right software.
It will be much easier to optimize your credentialing system if you utilize technology that automates processes that would otherwise be done manually or with spreadsheets. Up-to-date software streamlines workflows, keeps important documents organized, and can be easily configured to send alerts to remind you of approaching deadlines. You can readily track processes digitally, rather than spending hours playing phone tag with credentialing boards and payers. Documents can be signed and submitted electronically, saving time. Superior software integrates data from multiple sources to self-populate forms, eliminating the tedium and delays of manual data entry. Intuitive interfaces encourage staff to engage with the technology and allow them to locate information quickly. When you can expedite task-management, it’s easier to give payers ample time to process applications. The right software allows for timely, painless credentialing.