Want a Better Bottom Line? Get Serious About Better Relationships with Payers

Fast enrollment, fast reimbursement—that’s the name of the game for quickly earning revenue after joining a new health plan.

However, it’s rarely that simple. Provider credentialing and other on boarding tasks can take months of paperwork, and for all that, a provider still might end up with denied claims because he or she didn’t fill out the paperwork the right way.

This makes forging better communication with payers from the very beginning an absolute necessity. Additionally, providers should lessen dependence on just a few payers, and instead, focus on growing their practice revenue by signing up with more plans. One way to do so--without also growing their documentation requirements/is to offload on boarding and credentialing transactions to an online, subscription-based service. This frees the provider up to find and research more plans, knowing that the online service can do the actual legwork of joining them.

More importantly, the service can remove almost 100 percent of the friction that’s inevitable in any relationship that requires so much precise exchanging and logging of information. Some specific ways follow.

Brings Order to Provider Data

Even though insurers are their primary source of revenue, few providers relish on boarding with a new health plan. It’s a protracted chase for applications, licensing and credentialing forms, and other documents, none of which reside in the same location. Many practices have an employee in charge of on boarding and credentialing; however, they take their knowledge with them when they’re out sick or leave the job altogether.

Further, it’s difficult for one or two people to stay on top of all the requirements America’s hundreds of different health plans require—another big reason why providers are enrolled in far fewer plans than they could be.

To that end, one of the biggest benefits of an online credentialing service is that it centralizes all payer forms and applications in one location, easily accessible from any secure internet connection. Look for a service that also per-loads the most current forms required by almost every payer and health plan. It should also store the right contacts for each payer, plus the subsequently negotiated fee schedules. This will translate into major time saving down the road when it’s time to re-credential.

Most importantly, every authorized person in the practice has access to the information needed to enroll in a health plan and maintain productive, efficient communication with the payer.

Tracks Enrollment Status and Deadlines

Last year it was reported that 65,000 providers had been dropped from state Medicaid rolls/simply because they failed to re validate by a certain date. While this is a jaw-dropping example of how one paperwork oversight can have devastating consequences, it’s also an all-too-real example of how deadline and rule-driven dealing with payers (commercial as well as government) has become.

An online credentialing service can remove much of the risk of failing to meet an important deadline or filing the wrong application. It tracks status of in-progress applications, flags if certain documents are missing, and sends alerts of upcoming deadlines for credentialing applications, license and malpractice renewal and more.

Sets Up a Successful, Long-term Relationship with Payers

Online credentialing services offer a refreshingly simple way to get credentialed and earn revenue more quickly. But they are increasingly branching out to be even more. Some subscriptions also enable providers to “mass” communicate Provider Directory updates to payers, a task that left undone, can badly fracture both payer and prospective patient relationships. By automating it online, all participating payers receive the updates, saving a great deal of time for the practice office.

Additionally, an online credentialing service can serve as a recruitment vehicle for payers seeking new providers. When expanding networks into a certain area, payers can reach out through the service to potential providers. Now health plans are seeking out providers instead of the other way around.

While turning credentialing and on boarding into an electronic process won’t solve all relationship problems with payers, it will certainly go a long way in making these relationships more profitable. And at the end of the day, that’s what both providers and payers want. Now they can work in better harmony to achieve it.

Neerak K. Sharma is the Chief Operating Officer at Santéch Solutions, whose groundbreaking solutions I-Enroll, I-Network, and I-NetXchange liberate providers and payers from the onerous paper documentation associated with managing their relationships.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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