A simple provider enrollment or credentialing error can stop your physician or nonphysician practitioner from being reimbursed for treating patients.

When you implement these 7 strategies you will be on your way to filing complete, accurate applications that get approved quickly so you can keep your patients provided for and your reimbursements coming.

#1: Keep Track of Provider Enrollment Moving Parts

Provider enrollment really is a juggling act. Each form, credentialing detail, documentation, communication, and industry change is a ball that you must keep in the air. Keeping track of these details is no easy task, but to succeed, you must remain organized. There are several credentialing tools you can use to help organize your credentialing data, including:

• Credentialing software. Credentialing software can help you track and update provider information and notify you of deadlines or renewal dates. Some of these management systems are also available as cloud-based options.
• Microsoft Excel is an excellent spreadsheet application that you can use for credentialing tools to track your physician data. With a spreadsheet, you can easily sort and filter the data to analyze it in different ways, track provider credentialing status, and highlight important dates and completion status.
• Calendar reminders. You can input important dates into your electronic calendar and set up alerts for reminders so you don’t miss any deadlines.

#2: Educate to Establish A Successful Provider Enrollment Process

The key to a successful provider enrollment is to get applications where they need to be accurately on the first pass so you can get approvals back as quickly as possible. You can’t do this alone! You need support from your entire organization, and you can get this when you educate them on the importance of provider enrollment and the impact it has on your revenue. Here are some great ways to educate your organization:

• Explain to providers why it’s so important to get paperwork back to you so quickly. Let them know that provider enrollment and credentialing is directly related — therefore vital — to your revenue stream.
• Put information in newsletters about credentialing and provider enrollment so other departments in your organization are aware that these directly affect your reimbursements.
• Make credentialing and provider enrollment part of your organization’s vision and mission statement because they have such a big impact on your practice’s financial health.
• Work with your executive leadership to provide ongoing education and awareness on the importance of provider enrollment.

#3: Establish a Successful Process for Obtaining Provider Enrollment Application Information

A comprehensive communication plan is key to obtaining all the provider enrollment application you need. This includes communication within your practice as well as externally with the insurance carriers and hospitals. It’s important to create a system that all staff know and have access to, and that allows you to track where the application is at in the process. Keep these tips in mind when creating a provider enrollment application process:

• Create a communication plan between you, the provider, and any other party involved directly or indirectly in this process.
• Communicate from the beginning what information is needed, including expectations and timelines and the reason why you need this information.
• Create a process internally and externally to identify each team member’s role and responsibility.
• Make sure the requirements for each plan or hospital including applications, additional documents, and accepted submissions options are clearly defined and understood.
• Get commitment from the top down in your organization to not only adopt a streamlined process but also continue to review and adjust as necessary.

#4: Complete Applications Accurately

Incomplete and inaccurate applications will cause a delay or denial. That’s why it’s so important that you fill out the applications carefully, completely and clearly. Make sure all the information you obtain is accurate and clearly identified. Document the process and timeline expectations to your organization and provider. Read the instructions carefully! If the provider needs to include three references for hospital credentialing/privileging, there are guidelines to follow:

• One reference should be someone who has personal knowledge of current clinical skills, observation of work, and ability to work cooperatively with others
• Another reference should be a professional peer reference from a practitioner in the same specialty
• Another reference should be someone who has recently been responsible for the applicant’s practice at a healthcare organization (department/section chair, chief of staff, etc.)

#5: Review Your Applications Thoroughly

Review your applications before you send them! Don’t just assume they are complete after the provider has completed them. When you review, keep a sharp eye on these details:

• Make sure that you identify all the timelines from the time the provider went to school until today so that any gaps are explained
• Review for missing information/unanswered questions
• Check that all “Yes” affirmative answers to disciplinary questions are explained
• Look for discrepancies in the application/CV/verified information and between the application and primary source as well as inconsistent answers

#6: Be Aware of Red Flags

While you can’t always avoid certain things that cause your application to be denied or delayed, you can at least be prepared. Knowing your provider enrollment application has a red flag on it will at least prepare you that the process may take a little longer and you can prepare your provider for this delay as well. Some red flags that insurance companies look for include:

• Missing dates/gaps in practice
• Interruption of training programs
• Change in hospital staff category
• Discipline by licensing entity
• Frequent moves
• Voluntary resignation under threat of discipline
• Liability coverage canceled
• Malpractice claims

#7: Enroll in Online Credentialing Training

To get the inside scoop on what you need to do to file more accurate applications and avoid delayed or lost reimbursement due to credentialing errors, have your credentialing team attend an interactive online training.

This is a great way to develop your processes and get a firm handle on the basics. A 90-minute online training session, such as Credentialing 100 for Your Practice from credentialing and enrollment expert, Tracey Tokheim, will walk you through the most important aspects of provider credentialing and enrollment, and help you ensure everything sails through the approval process the first time.

Provider Enrollment Training and Resources