We wanted to take a few minutes and educate our visitors about some of the challenges you could encounter during the provider enrollment process. These challenges apply whether you are a facility enrolling a new provider or a physician or mid-level practitioner attempting to enroll with the insurance company. They are also challenges experienced during the enrollment process regardless of where you are located.
We have enrolled thousands of providers over the years and one of the most challenging aspects has to reside in the customer service/provider enrollment department of the insurance companies. Poor customer service is in many cases the #1 roadblock to physicians and providers attempting to enroll withe insurance companies. Oftentimes, providers will get a completely different answer when going through the 800 number vs dealing with the local provider rep. Unfortunately, many insurance companies are doing away with their local provider reps in exchange for a team of customer service reps(often in different countries) that have little to no idea about the local market.
In addition to the customer service issues, the next hurdle that most providers encounter during the process is in the contracting process. Many times providers will complete the enrollment/credentialing process but run into road blocks during the contracting process. Contracts are mailed or emailed to the provider with little to no explanation of exactly how they will be compensated and how it compares to market rates. Because of this, many providers sign contracts that end up paying them 10-15% less than what would be considered fair market rates. Rates are not standardized which means payers have the opportunity to pay you more or less depending on how generous they are feeling.