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January 17, 2023

Why Outsource Provider Enrollment and Credentialing?

Why would a health care organization consider outsourcing provider enrollment or credentialing? Health care providers must complete the provider enrollment process before being able to bill insurance companies, but the procedures can be lengthy, complicated and susceptible to mistakes. Mistakes can lead to delays in provider onboarding, which could cost a group $10,000 or more a day in potential revenue. 

Outsourcing can lessen the administrative burden on staff, cut turnaround times by a significant degree through experienced process management and allow providers to bill insurance payers faster than ever.  

Key Takeaways: 

  • In-house provider enrollment and credentialing takes staff away from patients and traps them in a lengthy process creating frustration which can lead to chance for error 
  • Mistakes made or missed during the provider enrollment process can further delay an already time-consuming process 
  • Applications vary by insurance companies which mean each individual medical practitioner could require dozens of applications to be filled out on their behalf 
  • The newly expanded partnership between Anders and Fifth Avenue Healthcare Services can alleviate the burden of provider enrollment and streamline the credentialing process, creating more opportunities for revenue  

What Makes the Provider Enrollment and Credentialing Process so Burdensome on Staff? 

The process of provider enrollment is multi-faceted and takes a focused effort to keep track of not only documents submitted by medical professionals but also numerous payer applications. Each payer has a different application process, and each state has its own requirements, making the process that much more complicated. 

Additionally, staff charged with overseeing the credentialing process must also investigate and verify all documentation submitted by medical professionals to ensure there are no inaccuracies that need to be corrected. While vitally important to ensure prompt payment from payers, verifying this information is time-consuming, taking staff members from being able to assist with other, more patient-focused work. Neglecting this vital verification step, even accidentally, can lead to further delays when applications submitted to payers.  

After applications are submitted to insurance companies, there’s still work to be done. The payer review and credentialing process can take several weeks to complete. On average, payer credentialing can take between 30 to 180 days or even longer. For example, if the payer discovers any inaccuracies in the provider’s information that need to be addressed or if they request additional documentation. These delays can be costly but prevented when the process is performed correctly.  

Benefits of Outsourcing Credentialing and Provider Enrollment Services  

Turning to an outsourced credentialing and provider enrollment service frees staff members from the burdens of the credentialing process and gives them back their time to focus on providing excellent patient care. Outsourced solutions, like the one offered by the Anders partnership with Fifth Avenue Healthcare Services, streamline the process for health care providers, leading to fewer steps overall and tighter turnaround times, allowing payers to be billed faster.  

Fewer Steps, More Delegated and Non-Delegated Options 

Fifth Avenue’s sister brand Primoris Credentialing Network, the largest credentialing IPA in the Midwest, provides over 54 delegated and non-delegated health plans and network provider enrollment options, many of which can be applied for with using one application. Fifth Avenue’s sister brands also reduce the number of steps from 52 to just six simple steps.  

In addition to credentialing, Anders also offers provider enrollment and state licensing board services. Together, these three services can provide solutions to keep your medical professionals properly credentialed and their state licenses up to date. As these services must be performed routinely, Anders monitors applications to ensure there’s no gap in coverage so you can continue to care for patients with confidence.  

To ensure the provider onboarding process is as smooth as possible, Anders develops relationships with payers and creates a point of contact. By creating a channel of communication with the payer, Anders can work with payers on denied claims and possibly have those denials reversed. This is a level of communication that other providers simply don’t do.

Outsourcing the credentialing and provider enrollment process can shorten wait times, reduce opportunities for error and can even lead to increased revenue. Anders Health Care advisors can become an extension of your existing staff and alleviate the administrative burden. Contact an Anders advisor below for more information.  

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