Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Reimbursement News

How Automating Payer Enrollment Reduces Time to Reimbursement

A lack of automation for payer enrollment and other claims management processes is delaying reimbursement, but outsourcing payer enrollment can reduce the wait.

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Sponsored by symplr

- Manual claims management processes significantly slow down time to reimbursement. However, payer enrollment services can help healthcare organizations digitize the key claims management step to reduce the amount of time providers spend waiting for payments.

While new health IT systems and tools promise to speed up healthcare and improve outcomes, providers are not necessarily implementing and using these innovative technologies for claims management.

In fact, the Council for Affordable Quality Healthcare (CAQH) recently reported that healthcare organizations are taking a step back from automating claims management. The non-profit alliance found a 55 percent increase in the volume of manual transactions by providers in 2017 compared to the previous year.

As a result, the savings providers could incur from adopting electronic claims management processes increased to $9.5 billion in 2017.

Healthcare organizations could also save a significant amount of time by transforming their manual processes, CAQH found. Manual processes create a lag in claims reimbursement. Manual claim payment cost providers an average of four minutes, while an automated payment would only have taken three minutes on average.

Recouping one minute of a provider’s time may not seem worthwhile. However, healthcare organizations send thousands, if not millions, of claims each year. Medicare alone processes five million claims worth $2 billion a day.

Slow provider processes also add to the amount of time payers take to reimburse healthcare organizations. Payers already take weeks to process a claim and remit reimbursement to providers.

Accelerating the time to reimbursement is key to running a smooth healthcare revenue cycle. And automating a key component of the revenue cycle and claims management processes — payer enrollment — can be vital to reducing the amount of time healthcare organizations are waiting on reimbursement.

Payer enrollment (also referred to as provider enrollment) is the process of becoming part of a health plan’s network or networks. The process includes completing provider credentialing, contracting with the payer, maintaining certifications, and reapplying for ongoing network inclusion in subsequent years.

Failing to accurately complete payer enrollment will result in claims reimbursement delays, and even claim denials. Payers will not reimburse providers who are not officially part of their health plan’s networks.

Despite payer enrollment’s importance for timely reimbursement, most enrollment and disenrollment applications are manually processed. One large national health plan told CAQH that just one-half of their enrollment and disenrollment applications were fully electronic.

As evidenced by CAQH’s findings, manual processes lengthen the amount of time it takes for providers to get paid for services they deliver to patients. Yet, healthcare organizations have not fully automated their payer enrollment services to shorten the timeframe between delivering services and getting paid for them.

Payer enrollment services can help healthcare organizations implement a streamlined process for credentialing, contracting, and revalidating.

Automating payer enrollment services through a third-party

Outsourcing payer enrollment to a third-party gives a healthcare organization access to the automated workflow of the vendor. Rather than building an in-house solution, healthcare organizations can leverage the technological capabilities, as well as the expertise, of a third-party company that is dedicated to payer enrollment.

Enlisting the help of a payer enrollment vendor can also allow medical services staff and physician services groups to do away with their manual checklists. Traditionally, staff have used checklists to ensure they have all the documents, certifications, and other paperwork needed for a provider to apply to a health plan’s network.

However, each payer requires a different set of documents for enrollment in their networks. Managing the different needs of each payer can get complicated when medical services staff rely on paper-based checklists to complete payer enrollment.

Manual checklists and spreadsheets particularly pose a problem for growing organizations. Organizations adding new facilities and hiring additional providers need the scale of an automated process to complete payer enrollment in a timely manner and get paid for provider services.

By outsourcing payer enrollment services, healthcare organizations do not have to use manual checklists to gather and track documentation. The third-party company works on behalf of the organization to obtain, verify, and send the necessary documents for each payer through its automated system.

“Different payers may have different rules for network participation, enrollment and revalidation deadlines, which can make the process of enrolling with payers complex for healthcare organizations,” said Patrick Birmingham, Vice President of Operations, Payor Enrollment Services at symplr. “Outsourcing to partners who really know the ins and outs of payers can save precious time for organizations struggling to manage so many details.”

The automated payer enrollment process ensures providers are enrolled and reenrolled in a timely manner with minimal disruptions to a provider’s network participation. Therefore, payers, providers, and healthcare organizations benefit from a more streamlined enrollment process and revenue cycle delays can be mitigated and often eliminated lending to a more productive healthcare delivery system.

The timely enrollment of providers into health plans has become a crucial requirement of sustaining a thriving practice. symplr’s payor enrollment services can help you reduce the paperwork burden, streamline your provider onboarding process and enhance the profitability of your healthcare organization. We make payor enrollment simpler for healthcare organizations nationwide. For more information, email [email protected] or visit us at symplr.com. 

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