Healthcare groups deal with many insurance companies. Doctors must sign up with each insurance company to get paid on time.
But, these insurance companies have different ways to sign up. The people who work in healthcare must know how each insurance company wants them to sign up.
For example, Humans need doctors to use a CAQH Proview service to give their information. Doctors also need a special certificate for certain medications.
Aetna is similar. They want doctors to use CAQH Proview, too. But they also look at a doctor’s work quality using rules from the National Committee for Quality Assurance.
All these different rules and forms can slow down the process at a healthcare group. Claims might take longer to get approved.
Hiring a third party can help. They know how each insurance company works. They can help healthcare groups follow all the rules and forms.
These third-party companies should work with each insurance company the healthcare group uses. They must understand how each insurance company wants doctors to sign up for their plans.
Streamline payer enrollment to save time and money
Enrolling as a payer can be tricky and long. It often takes many months.
Usually, payers need 90 to 120 days just for provider credentialing. This makes the whole enrollment process take months. Smaller plans with fewer resources might take even longer to finish provider enrollment.
Sometimes, healthcare groups can make things worse. They might not collect all the needed papers for credentialing. They might also do the same work more than once, which slows things down. When things take too long, this can delay getting money for claims (and more denials).
Let a third party handle payer enrollment is one way to improve things. They can help with getting the right papers for credentialing and enrollment. They can also track what the payer says about provider participation requests.
When payer enrollment goes smoothly, providers can start seeing patients and getting paid for their work sooner.
Understanding Payer Rules And Requirements
Healthcare groups work with many different payers. Doctors and nurses who work with them need to sign up with each insurance company to get paid on time.
But, private and public payers need a standard way to sign up. The people who work in healthcare need to know the rules and requirements for each payer.
For example, Humana wants providers to use the CAQH Proview by the Council for Affordable Quality Care (CAQH). Providers also need special certificates.
Aetna is similar. They want providers to use CAQH Proview too. But they also use the National Committee for Quality Assurance (NCQA) standards to check if providers are good enough.
Dealing with all these different payer rules and forms can slow down the whole process in healthcare. It can make claims take longer to process.
To make things easier, healthcare groups can partner with any professional medical billing company to help with payer enrollment. These helpers should work with each payer the healthcare group deals with. They should understand each payer’s special rules forms and how to add a provider to a health plan’s network.
How to stay on the top
More than just ensuring healthcare providers are in the right payer networks is required. Payer enrollment is an ongoing task.
Payers want providers to re-enroll or verify their qualifications every few years. This ensures they can still provide good care. For example, the Affordable Care Act made Medicare providers revalidate every five years.
If providers do not re-enroll by a specific deadline, healthcare organizations can not send claims or bills, and they might lose billing rights.
Claims might get delayed or denied if organizations do not update provider information and certificates regularly.
Keeping track of when each provider’s enrollment and certificates expire takes a lot of time and can lead to mistakes. But outsourcing payer enrollment services does this job.
Payer enrollment services also keep provider data current on important platforms like CAQH’s Proview.
Outsourcing payer enrollment helps healthcare organizations, payers, and providers communicate better. This ensures that registrations get approved and stay approved.
When the payer enrollment process is more open, healthcare organizations can expect to get their claims paid on time and with fewer problems.
Conclusion
Enrolling providers in health plans on time is essential for a successful practice. Payer enrollment services can make things easier. They reduce paperwork, smooth provider onboarding, and boost your healthcare organization’s profits. We help healthcare groups all across the country with payer enrollment.
FAQs
What are the main kinds of payers?
There are three types of healthcare payers: commercial, private, and government/public. Commercial payers are companies you can buy stocks in, private payers are private insurance firms, and government/public payers are government-run plans like Medicaid and Medicare.
What makes someone a good payer?
A good payer either pays you fast or a lot of money. On the other hand, a lousy payer either takes a long time to pay you or pays you little. I’ve always been a good payer and never got into debt.
