Payor Enrollment Mistake #6: Failing to Verify Your Supporting Documents are Current

DO NOT WAIT! That is our message and our mantra when it comes to perishable documents. What is a perishable document? A perishable document is a document that has an expiration date.

One of the most common mistakes people make, when submitting their payer enrollment application, is submitting their application with expired supporting documents. Like rotten fruit, expired documents are spoiled. Submitting expired documents will delay the payer enrollment process and may result in your application being rejected.

This is why our message to you is DO NOT WAIT! When it comes to perishable documents, do not wait until the last minute or let them expire. It is important to stay in front of the renewal process and make sure your supporting documents are properly maintained and current.

To help you stay in front of the process, we have provided a checklist of five KEY perishable documents we recommend you actively monitor and ensure are current prior to submitting your payer enrollment application.

1. Medical Licensure – You must hold an unrestricted and current license to practice for each state you practice in. Each state board requires that you renew your license every 2 to 3 years. If your license is not renewed by its expiration date, you are prohibited from practicing. If you continue to practice under and expired license, you may face many legal ramifications.
   Why this matters: When your payer enrollment application is reviewed, if the date on your submitted medical license has expired, your application will be rejected, even if, you successfully renewed your license prior to expiration. If your current license is about to expire, renew your license before submitting your application. Remember the application process can take 30 to 60 days.
2. DEA – Like your medical license, your DEA Registration has an expiration date and is required to be renewed every three years. If you fail to renew your DEA license your prescription writing ability for schedule four drugs will be revoked.
   Why this matters: If your proof of DEA Registration is expired or expires prior to your payer enrollment application review, your application will be rejected.
3. CAQH – Avoid your CAQH account from lapsing. This is such an important step in the payer enrollment process, you will find “avoiding your CAQH from lapsing” as the #1 mistake to avoid in our top 9 list.
   Why this matters: The CAQH is a database most payors use for medical credentialling you into their network. Without an active or current account, your payer enrollment application will be rejected.
4. CEUs – Each state requires a certain amount of continuing education units each year. If you lose track of time and don’t meet the required number of CEUs, you may be sanctioned by your state board.
   Why this matters: If you are sanctioned by your state board, the sanction will follow you, even after you meet the CEU requirements. It is a permanent mark. Such sanctions can impact your payer enrollment application and delay the process. It is best to avoid any mark to your record.
5. Malpractice Insurance – Forgetting to renew your malpractice insurance can lead to disastrous consequences. Keeping your malpractice insurance up to date is critical.
   Why this matters: If your proof of malpractice insurance is expired your payor enrollment application will be rejected even if you have renewed it. When submitting your payer enrollment application, make sure you provide the most recent proof of insurance that will not expire in the next 30 to 60 days.

In our experience, most practices keep their license, insurance, and other regulatory requirements current. Remember, the mistake to avoid is submitting an old document or a document that will expire in the next 30 to 60 days. Make sure everything is current and DO NOT WAIT!

To learn more about the payer enrollment process and the mistakes to avoid, we recommend reading our blog: Avoid the Top 9 Enrollment Mistakes and Checklist.