Payor Enrollment Mistake #8: Failing to Review Your Provider Type

Payor Enrollment Mistake #8: Failing to review your provider type and make sure all the required fields are complete, and the information is accurate.

There is nothing more frustrating than having a payor enrollment application rejected or delayed because one piece of information is missing. It is even more infuriating to have a payor enrollment application returned over and over again because of missing information.

This back and forth can dramatically slow the approval process.

Submitting a payor enrollment application with incomplete or inaccurate information is our #8 most common mistake to avoid.

Why is this such a common mistake? Where’s the rub?

The rub in the payor enrollment application is the provider type. At its core, the payor enrollment application form is a universal application form. This means every possible field is listed on the form but not every possible field is required for every applicant.

The fields an applicant need fill out are dependent upon the applicant’s provider type. Knowing your provider type is key to successful submitting a complete payor enrollment application.

Which provider type applies to me?

This is a surprising difficult question to answer in some cases. The payor enrollment application is designed to provide the insurance companies the information they need to create a picture of your organization to determine if you are a good fit for their provider network.

Simple enough conceptually. The challenge is the descriptions or definitions the insurance companies use to describe your organization are not always clear or obvious. In some cases, the provider types are very granular and look a lot alike. Picking from the list of provider types can feel like splitting hairs.

If you find yourself uncertain of the provider type to choose, don’t guess. If you pick the wrong provider type, it is very difficult to correct; and more often than not, picking the wrong provider type will require you to start over.

The reason is the fields a provider is required to fill out are dependent upon the provider type. Also, the selection of provider type may impact the manner in which the payor enrollment application is processed and reviewed.

Picking the wrong provider type at the start of the process is more often than not a road to starting over. Before starting the payor enrollment application process, make sure you properly identify and verify your provider type.

If you are uncertain of which provider type to select, there are available resource to help you decide; but in our experience, it is always best to consult an expert.

A few useful resources we recommend:

• https://www.cms.gov/browse-provider-type

• https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Find-Your-Taxonomy-Code

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