In the ever-evolving healthcare industry, the push for faster, more efficient services has become increasingly crucial. With the U.S. healthcare expenditure projected to reach $6.2 trillion by 2028, organizations are under immense pressure to optimize their operations and maximize revenue generation.
One of the key areas where improvements can be made is in the payer enrollment process. Streamlining this critical step not only ensures that healthcare organizations can meet the rising demand for services but also helps to accelerate revenue realization.
To stay competitive and maintain a strong financial footing, it's essential to adopt best practices and innovative strategies.
Let’s dive into six actionable steps your organization can take to enhance its payer enrollment processes, ultimately leading to faster revenue recognition and a healthier bottom line.
1. Maintain accurate and up-to-date payer information
Providers must have access to current, accurate, and comprehensive payer information to streamline the enrollment process.
This includes payer network participation requirements, payment policies, claim submission protocols, denials management guidelines, provider credentialing requirements, reimbursement rates, and timely filing limits.
Establishing a centralized database with the latest payer information can facilitate easy access for healthcare providers and expedite the enrollment process.
Takeaway: Having current and accurate payer information allows healthcare organizations to submit claims correctly and efficiently, reducing the chances of denials and delays in reimbursement. This ultimately helps realize revenue faster as claim processing times are shortened.
2. Understand “payer enrollment 101” (aka stay well-versed in payer rules and policies)
As both providers and organizations can enroll with payers, it’s important to understand what payers expect - and the common items that will be requested from you and/or your providers. Some of those items include name, NPI, education level, work history, board certification, existing licenses and government documentation.
Additionally, familiarize yourself with network participation policies, payment terms, denials management guidelines, credentialing requirements, reimbursement rates, timely filing limits, prior authorization protocols, and other relevant rules and regulations.
Regularly updated databases and manual checks against regulatory changes can help organizations demonstrate compliance and improve their chances of quick acceptance by insurance payers.
Takeaway: By staying well-informed about payer rules and policies, healthcare organizations can better navigate the enrollment process, ensuring that they meet all necessary requirements. This helps prevent any issues or delays in enrollment, allowing organizations to begin billing and receiving payments sooner.
3. Get clarity on what you need
Understanding the different types of enrollments your organization needs will help expedite your enrollment process. If your goal is to get in-network and reimbursed by payers, you’re looking for payer contracts.
If you’re looking to allow your organization to bill for services rendered by your groups’ providers, you’re looking for a group enrollment.
If your provider or group has existing enrollments, but you need to make updates to an address or practice location, that’s a demographic update.
And lastly, if you’re looking to enroll a provider with a payer, that’s provider enrollment.
Takeaway: Being aware of the specific enrollment types needed for your organization enables you to focus on completing those enrollments promptly and accurately. This can accelerate the enrollment process, leading to quicker reimbursements and faster realization of revenue.
4. Utilize automated tools
Creating a streamlined workflow with clever automation can reduce errors, prevent duplicate efforts, and improve overall efficiency. Establish clear procedures and roles for all team members involved in the enrollment process, invest in tools and training to maintain smooth operations, and use templates for frequently used documents to save time.
Takeaway: Leveraging automated tools (like Medallion!) allows healthcare organizations to process claims more accurately and quickly, allowing you to collect revenue faster.
5. Maintain granular visibility
Ensure you can support the ability to track every step of your workflows. This might mean building a dashboard that gives your staff visibility from an application request to completion, define clear and consistent statuses for your team to use, and clearly communicate to providers when payers request more information.
Takeaway: By investing in visibility, healthcare organizations can ensure that they are better equipped to handle enrollment tasks efficiently, leading to faster enrollment, fewer delays, and quicker revenue realization.
6. Optimize communication — but don’t overengage with payers
This may seem counterproductive to some, but it’s true. While we all want enrollments to move as fast as possible, payers have specific workflows, so it’s best to lean into their timelines and follow-up accordingly. Don’t give up or get discouraged - it takes working with payers long enough to fully understand the ins and outs. Some additional tips:
- Make sure you receive a submission confirmation – this may be immediate, or you may need to follow-up within 5-10 days.
- Confirm payer timelines and adhere to them. If the payer states it will be 30 days before an update can be given, follow-up accordingly. Reaching out before the 30 day mark will not get you a faster result.
- If you don’t have a follow-up timeline from the payer, stick to consistent follow-up every 10 business days.
- This process can typically go one for 90-120 days – don’t give up or get frustrated.
Takeaway: Sticking to a consistent follow-up process and leaning into payers’ timelines can contribute to a smoother and faster enrollment experience, which in turn enables organizations to start billing and receiving payments more quickly, ultimately realizing revenue at a faster pace.
Meet Medallion
Medallion offers a full providers operations solution that streamlines payer enrollment, payer contracting, and more, empowering healthcare organizations to maximize revenue and reduce administrative burdens.
With a deep understanding of payer requirements, Medallion ensures that your organization achieves faster enrollment and compliance with the ever-changing healthcare landscape.
Medallion is the go-to solution for healthcare organizations seeking efficient, accurate, and seamless payer enrollment processes that save time and increase revenue — no need to worry about manual processes or disjointed systems that cause delays and errors, Medallion has you covered.
Why Medallion?
An end-to-end solution
Medallion provides complete payer enrollment services ensuring a smooth and efficient process that saves your organization time and resources.
Experienced operations team
Medallion's team of payer enrollment experts are well-versed in navigating the complexities of healthcare contracting, providing guidance and assistance throughout the entire enrollment process.
Continuous compliance monitoring
Medallion proactively monitors healthcare regulations and payer requirements to ensure that your organization remains compliant and is always up-to-date with industry changes.
Integration with existing workflows
Medallion integrates with your current processes, further streamlining your organization's processes and improving data accuracy.
Customizable workflows
Medallion allows you to customize workflows to fit your organization's specific needs, ensuring efficiency and adaptability as you grow and evolve.
Secure provider data storage
Medallion's secure platform ensures that your organization's sensitive data is protected, while also providing easy access to information when needed.
Benefits of a payer enrollment platform or tool
A payer enrollment platform simplifies the management of healthcare provider and health plan relationships, increasing efficiency and reducing errors in administrative processes.
- Increased efficiency and reduced errors: Tools like Medallion automate administrative tasks, reducing the risk of human error and allowing staff to focus on critical responsibilities.
- Centralized data management: Payer enrollment tools centralize provider data, simplifying tracking, monitoring, and updating of information, and facilitating sharing with stakeholders.
- Enhanced compliance: A payer enrollment platform streamlines compliance with regulatory requirements, automates tasks, and offers real-time alerts for potential issues.
- Improved admin and provider experience: Streamlined payer enrollment processes reduce administrative burdens, enabling providers to focus on quality patient care and easily access their information.
- Better reporting and analytics: Payer enrollment platforms offer valuable insights and data-driven decision-making through advanced reporting and analytics capabilities, optimizing enrollment processes and operational efficiency.
A payer enrollment platform or tool offers numerous benefits for healthcare organizations and providers. Putting in place the six key steps and leveraging a platform built to streamline these workflows, healthcare organizations like your own are better positioned to navigate the complex payer enrollment process with ease.
Ready to transform your healthcare organization's contracting and enrollment processes? Experience the Medallion difference today.
