The Top 9 Payor Enrollment Mistakes

Payor Enrollment is an essential process for medical providers to be reimbursed for services provided to patients. Although an essential process, many medical providers struggle getting accepted into a network. 1st Credentialing has found this to be true for both new and established medical clinics.

The primary reason most medical clinics find the payor enrollment process challenging is due to experience. It is not something they do very often; and as a result, they make mistakes.

Over the past 10 years, we found the majority of the mistakes resulted from incorrect information, lack of accuracy, and lack of follow up.

In order to help our clients successfully navigate the Payor Enrollment process, 1st Credentialing has developed a payor enrollment checklist based on the “The Top 9 Most Common Payor Enrollment Mistakes.”

How to Avoid the Top 9 Payor Enrollment Mistakes:

#1: Avoid your CAQH account from lapsing / Ensure your CAQH is updated before the credentialing process. A change in status will significantly delay or cause your insurance request to be rejected. It is best to start the payor enrollment process after creating or updating your CAQH account.

#2: Confirm realistic timeframes for processing. From contracts to credentialing, it is important to verify timeframes with payors so you understand which patients you can see in-network and which ones you cannot.  Setting realistic and accurate expectations is important. Typical time frames are from 90-150 days once a carrier receives the application.

#3: Make sure to sign the form and make sure the right person signs the form. This sounds silly, but it is one of the most common mistakes. You don’t want to go through all the work only to have your acceptance delayed because of a signature. Double check all signature pages before submitting and ensure the person signing is authorized to do so.

#4: Actively manage the process and provide prompt response. There will be requests for more documentation or clarifying information. Make sure you respond quickly to those requests. If you fail to respond within their timeframe, your request will be denied. You may also risk supporting documents expiring during the review process, so be sure to track those in CAQH.

#5: Always use full and complete legal names. When completing your provider form and when submitting supporting documents, make sure you consistently use the full legal name for your medical practice and the full and complete legal name for the authorizing agents and / or signatories. Always remember, your goal is to make it easy for the reviewer to verify and validate your information.

#6: Verify your supporting documents are current. This is an easy mistake to avoid and a very common mistake most people make when filing an application. Make sure the supporting documents are current and not expired. Submitting old documentation will result in unnecessary delays and aggravation.

#7: Check for clarity and spelling. The people reviewing your form will NOT give you the benefit of the doubt. Typos, hard-to-read copies, and poor penmanship can cause a delay in your acceptance into a plan and require you to resubmit your Payroll Enrollment forms.

#8: Review your provider type form and make sure all the required fields are complete and accurate. Not every field on a provider type form is required. Knowing which ones to complete can be confusing. Failing to fully complete your provider type form can delay your acceptance into the network. If you are unsure about a field, take the time to check whether it is required for your specialty or circumstance.

#9: Make sure you have the correct form for your provider type and specialty. Many forms have similar acronyms and numbers. If you don’t have the right form, your enrollment request will not be accepted, and you will have to start the process over again.

At 1st Credentialing, we strive to make the Payor Enrollment process as simple and easy as possible for our clients. To learn more about 1^st Credentialing, please visit our website, where we discuss all the latest credentialing trends and news.

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At 1st Credentialing, we look forward to partnering with you today!