Payer Enrollment for New Practices: When To Start the Enrollment Process

If you are starting up a new health care practice, be warned – it’s never too early to begin the payer enrollment process!

In our earlier blog on Payer Enrollment for New Practices: Selecting Insurance Carriers, we discussed points to consider when choosing the right providers for your practice and geographic area. 

In this part of payer enrollment basics for new practices, we will discuss how critical it is to start the insurance enrollment process early.

Provider Enrollment for Commercial Insurance Networks

Typically, it can take 90 days to be enrolled with commercial carriers. Submit a participation request to each health plan using its own application process. Some plans use CAQH in conjunction with an application or a state standardized application while others have their own unique form.

Before you sign up with the various insurers, make sure that you review each contract thoroughly. While in the contracting phase, you’ll have the opportunity to negotiate the insurer’s fees. This may mean a delay in the overall credentialing and contracting process as the negotiating process can take up to 6 months.

Once your agreement is approved and returned to the network, your tax ID is in the system for your organization and a contract with fee schedule is in place. Now it’s time to credential the providers to the contract, which is when carriers

who have provider numbers will issue them. Each provider will get a separate effective date that determines how far back the billing can go.

Payer Enrollment in Medicaid, Medicare and Tricare

The provider enrollment process for government health programs is different than that of commercial insurers. Government plans have standard forms that must be completed and processed through their own systems. Medicare enrollment is handled by the PECOS online portal via the Centers for Medicare and Medicaid Services, or CMS. The Medicare enrollment process is extensive and attention to detail is a must. 

Medicaid is a state process and many states have their own online portals.

The payer enrollment process is lengthy. Remember, you won’t be able to receive “in-network” reimbursements until your contract is in effect and your providers are credentialed.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.