Provider Enrollment: How To Avoid These 4 Common Mistakes

You know it’s essential to be a provider with government and commercial insurance companies. Your practice needs steady patient referrals – not to mention cash flow! But are you mired down in the medical credentialing and provider enrollment processes by making these common mistakes?

Incomplete Information on Applications

Whether a government or other insurance plan, the organization needs a complete picture of your medical practice, both current and past, to determine if your business is a good fit for their provider network. It’s very important to submit complete information with each application including addresses, contact information, list of services, license copies and average patient profile.

Be completely candid and include any past legal problems your practice may have experienced. An enrollment application missing any of these components can cause delays and even a denial.

Using a payer enrollment service like 1st Assistant ensures that your applications are complete and in the right format. We may even uncover items that you have overlooked. 

Not Enough Lead Time

Be sure to allow plenty of time for your applications to be received and reviewed. Typically, commercial carrier applications such as Blue Cross take up to 90 days to complete, with government plans like Medicare and Medicaid taking up to 120 days. Submitting information late can delay your provider effective date and therefore your reimbursement opportunities.

No Follow-Up

Does your staff have time to repeatedly follow-up on your enrollment applications over a period of months? Constant follow-ups are essential to stay on top of the progress of your application as it advances through the plan’s review process. They won’t call you to give you a status check! Call or email your contacts regularly and keep notes from each contact.

At 1st Assistant, we do the follow-up services for you, and we will stay vigilant until you receive your in-network effective date.

Not Keeping CAQH Profiles Current

CAQH information must be re-attested quarterly and any updated license or insurance documents must be added with new expiration dates. If participating health plans and healthcare organizations access your data only to find it out of date or missing, your status with these providers may be jeopardized.

Let us manage your provider enrollment processes for you so you can concentrate on providing medical services to your patients. Credentialing is our ONLY business here at 1st Assistant!

Let Us Manage All Your Payor 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.