The insurance enrollment process is painfully slow and can certainly be overwhelming, even for those that have done this often. This is especially true because the odds are that you are up against time constraints and the payers don’t seem to care. The worst thing you can do is to cut corners just because you are in a hurry. You will end up paying for those cut corners with wasted time and frustration. Take a minute to review this article prior to starting the credentialing process.
five tips for an efficient payer enrollment process:
Payer enrollment tip 1:
- Organization & Banking: The first thing you’ll need is to have your organization filed within your state and obtain your tax id from the IRS. You can get credentialed under your SSN but we strongly advise against this. There are too many liability concerns associated with treating patients under your SSN. Once you have your company set up, one of the first stops you should make is at your bank and go ahead and set up your business banking account. This will be required for payer payment(EFT) registration and it is a good thing to have in place when starting the process.
payer enrollment tip 2:
- Location: Even if you are doing home care or telemedicine, you need to have a business location that is linked to your organization. If you are opening a traditional practice, you need to have your location in order prior to beginning the credentialing. The payers require you to have a location in order to begin the credentialing. In the past, you may have gotten away with using your home address to start but that is not the case anymore. There has been too much fraud in recent years and payers now verify the location to ensure it is a place of business.
payer enrollment tip 3:
- CAQH: For commercial credentialing(not Medicaid or Medicare), yo will need to have your CAQH profile created. Once your profile is created, you need to remember to attest your account and allow insurance companies access to your profile. There are a few steps to getting this set up which is covered in detail here: CAQH Registration Process
payer enrollment tip 4:
- Malpractice: For commercial insurance credentialing, the payers do require you to have an active malpractice policy ahead of your opening day. Some carriers will provide you with a policy effective date in advance of your start date to prevent you from paying for a policy that you’re not using. This is our recommendation. Find a carrier that is willing to work with you on this.
payer enrollment tip 5:
- Contact Details: At minimum, you need to have your phone number ahead of starting the credentialing process. The last thing you want is your cell phone number floating around on the internet for years to come. You also have to remember that you will need to update all of the payers with the correct phone number for your business once you have it if you don’t have it at the beginning. In addition to your phone number, we also strong recommend that you obtain your website domain when registering your business. This does two things, it ensures someone else doesn’t buy your domain name and it also allows you to provide the payers with an email address for your business when doing credentialing. This is less important that your phone/digital fax but is something to consider.
There is a lot involved with the insurance enrollment process but we hope these tips are sure to create a more efficient process for you. Please don’t hesitate to contact us with any questions. If working on the Medicare enrollment process, we found some great Medicare enrollment tips here
Updated 9.20.2022