Provider Information Technology At The 21st Century

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Provider-Payor Enrollment in the 21st Century Provider – payor enrollment is familiar to most, if not all of us. The complexities of today’s healthcare environment force organizations to revamp their strategies, while rounding up the usual suspects – people, pay, and processes – shifting employees around, realigning incentives, and rooting out inefficiencies. Adapting to real-world realities, we are often confronted with issues in a rapidly transforming landscape, we must be able to shift from an idea to a full-scale implementation within a minimal amount of time to let go of the old and adjust to new methodologies. The 21st century brought with it the rising tide of change tasking us to deal with the acceleration and deceleration of …show more content…

Provider enrollment and credentialing is complex, requires ongoing monitoring and crucial to practitioner reimbursement for rendering medical services. These processes are time-consuming, costly, and inflict levels of frustration on practitioners seeking applications to hospitals and health plans. In many instances, practitioners are focused on wrapping up their duties and responsibilities prior to leaving their current locations and procrastinate completing applications required of their new location. The steps involved in provider enrollment includes 1) the collection of all required information, demographics, education and training, licensure (medical and CSR), DEA registration, board certifications, malpractice insurance, claims history (5 years), work history, etc. 2) build and continually update CAQH 3) obtain NPI numbers, 4) Complete all payer plan applications 5) release applications to payer plans 6) continual follow up with the payer plans until the provider is fully enrolled and receives an effective date 8) communication with key individuals affected by the provider’s enrollment status, e.g. revenue cycle 9) re-credential all providers with each payer plan every three years. Understanding “why” credentialing and provider enrollment is essential; the impacts of timely and efficient process completion will heighten your credibility as

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