Evaluating The Credentialing And Payor Enrollment Processes More Complex And More Time Consuming
1484 WordsAug 15, 20166 Pages
An increase in the number of closed networks, reimbursement changes, and risk-based contracts are just a few of the factors making the credentialing and payor enrollment processes more complex and more time consuming. Small healthcare organizations could certainly manage this process in-house if they have the money, expertise and staff. However, larger healthcare organizations, especially those that are growing, expanding or experiencing turnover, will find credentialing and payor enrollment to be a time-consuming and costly endeavor. This is especially true if these organizations rely on manual methods like paper documentation and spreadsheets to keep track of all their applications, contracts and renewal dates.
Credentialing setup and…show more content…
Ensure that the vendor that you select has an in-depth knowledge of credentialing, contracting and provider enrollment as these are three completely different processes. Your vendor should have a deep understanding of state-specific payers and the best ways to maximize the processing of your applications and they should have established relationships with payers so they know who to call when follow-up is needed and you should expect a qualified credentialing vendor to follow up with payers weekly.
• How long has the vendor been providing these services? Ask for references that are at least 5 years old and ensure that these references are current clients. This will help to ensure that you are dealing with a company that not only knows how to obtain clients but also knows what it takes to maintain clients.
• Ask the vendor if they understand fee schedules and what percentage of Medicare you can expect from the major payers. This will help verify that the credentialing vendor understands how important reimbursements are for your practice. You can also ask them if they can help you build your fee schedule or assist your billing company or personnel. This will at least give you some validation (depending on their answer) that they know how to calculate fee schedules and understand their importance—as not all credentialing vendors understand contracting and fee schedules.
• Ask the vendor