Written by: Jessica Ullio
It is an age-old question like “What is the meaning of life?” and “How many licks does it take to get to the Tootsie Roll center of a Tootsie Pop?”
Provider enrollment, or completing and submitting providers’ health plan applications to participate and receive payer reimbursement, seems pretty straightforward. Yet, it can take 90 to 120 days to complete on average.
So why does a health plan take 120 days to process a provider’s application?
1. Provider credentialing takes time.
First, the health plan decides if the provider will become part of their network through ‘credentialing.’ This process typically verifies the provider’s qualifications (medical license, board certificate, etc.) to ensure the provider is competent and legitimate.
If everything checks out, the health plan approves the provider and issues them an effective date and a fee schedule for patient reimbursement.
2. Fluctuations in Application Volume and Processing Time
Currently, health plans experience delays with processing these applications, but not necessarily for the reasons you may think.
Payers are typically transparent about significant and prolonged lag times, citing major increases in applications and requests, oversaturation of one specialty in a given service area, periods of high turnover, outsourcing, significant backlogs, and system and process changes.
Tarah Vanhooser, Director of Provider Enrollment at Advantum Health, shares, “As a department, we regularly work with over 300 different payers and currently have clients in 35 states, so we’ve experienced it all. What I hear most about holdups, though, is big jumps in volume.”
These delays in the provider enrollment process can be frustrating – and costly – but constant communication with the plan through regular follow-up can help minimize lag time.
It helps to develop relationships with the large (and not-so-large) commercial and government payers and their many representatives so you can effectively advocate for your provider’s application.
3. Missing information and mistakes due to human error.
Another reason provider enrollment takes so long is good, old-fashioned operator error.
Each health plan has its unique requirements. The number one way to get your provider’s application shoved to the bottom of the pile is to make a mistake or fail to include the required information or documentation in your submission.
Even simple things like transposing NPI numbers or misspelling a street name can be enormous setbacks for your application process time, but Advantum’s got you covered.
At Advantum Health, we’ve set up a few tools to combat inevitable human error.
First, the less typing into the application you are doing, the less chance you have of making a mistake.
We’ve mapped thousands (and counting) of short and long health plan applications and forms within our provider enrollment software to allow our specialists to pre-populate your provider’s data with one click, slashing application mistakes and moving our clients’ providers through the enrollment process rapidly.
“I’ve seen a major decrease in application errors since we started using mapped applications rather than manually completing them. It’s made a big difference,” Vanhooser said.
Lastly, take a tip from your middle school math teacher and check your work. Before you call it good, give the application a once over and make sure everything looks correct.
Several quality assurance teams at Advantum serve as fail-safes to minimize errors on provider applications that will slow down processing. These experts comb through completed applications to catch mistakes or holes and correct them before they make it to the health plan.
In closing, while many factors influence how long getting providers enrolled will take, you aren’t necessarily a sitting duck. By controlling the elements of the process that you can, such as requesting updates frequently and ensuring your submission is accurate, you can get through provider enrollment in the fastest time possible.
To learn more about how Advantum Health can help your organization with provider enrollment, click here.