Getting payers to respond to your provider credentialing and enrollment questions sometimes feels impossible, but without their help, you won’t be able to process your applications, which means you can’t bill for new providers. There are, however, concrete ways you can reach insurers and get responses to your credentialing questions.
Check out five expert-tested ways to reach payers and speed your provider credentialing and enrollment processes.
1. Work Your Way up to Leadership
While your calls to payers will usually start with customer service representatives, they won’t end there if your issues aren’t resolved right way, which is why you must identify who you’ll contact next in the chain.
To get your questions and challenges resolved during the provider credentialing process, you need to know the lay of the land at your insurance company, since they all have different leadership structures.
For instance, your payer may have you start with customer service, and if they can’t resolve your issue, they may move you on to your account manager, who is tasked with resolving any issues your practice may have. If the account manager can’t assist, however, you’ll keep working your way up higher.
For the next step, consider asking for the provider relations manager. If that person is still unable to help, ask for the credentialing manager or director. This person overlooks the credentialing team for a specific regional area, and is an important person to connect with if you have credentialing issues. This position may go by a different name at different insurers, but once you work your way there, you should be able to resolve your problem.
2. When Needed, Escalate Your Request
If your issues aren’t resolved at the credentialing director level and you don’t hear from someone for a few weeks, you may need to send a message (via mail or email) to your payer contact saying you’re escalating your request to a supervisor level. You can send the email to your payer representative and cc everyone along the way who has ignored your request (for instance, the provider relations manager, the credentialing director, etc.)
In the written communication, note that you’ve waited two weeks (or the specific length of time you’ve been waiting) for a response and list all of the people you’ve contacted along the way, to no avail. Let them know that your provider credentialing process depends on their swift attention to the matter, and note that if you still don’t hear within two weeks, you’ll be contacting the medical director at the insurance company.
If you contact the medical director and still don’t hear anything, you may need to send a letter to the state department of insurance, but in most cases, the issue won’t get that far.
3. Document Everything or You’ll Have No Case
As with everything involved in insurance payments, denials and processing, you must document every detail or you won’t be able to escalate your case if needed. Document the date you speak to each person, what they said, their name, and the next steps they said they’d be taking.
You may think that it’s enough to have an email or a text message thread with your insurance contact, but if you go out of the office and someone else is trying to handle the credentialing process, they won’t have access to that information. So even if your communication is in writing, you should also document it in the file for the provider credentialing and enrollment process to ensure everyone can see it.
4. Never Give up
If you aren’t able to find a solution through the payer and you need to file a complaint with the state insurance department, it might be time to hire a credentialing consultant to help you through the process. But no matter what, there will always be a solution waiting, even if you have to get an outside expert involved. It’s important to try all avenues and never give up as you work your way through the provider credentialing process.
5. Send Appreciation to Everyone Who’s Helpful
Just as you put your complaints in writing when needed, you should also put any compliments in writing, particularly when someone goes out of their way to ensure your provider enrollment process gets taken care of. If you come across someone who is helpful, send them a note of appreciation over email and cc your provider relations representative so they know what excellent care you got along the way.
Seeking more provider credentialing and enrollment tips? Check out the 75-minute online training, “Speed Up Payer Credentialing/Enrollment Responses & Approvals,” presented by Olga Khabinskay, MBA. During the training, you’ll get insider tips that will help you sail through the enrollment and credentialing process and ensure you can collect for your providers’ services right away.
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