Unfortunately, we see many healthcare providers submit incomplete or incorrect applications mainly due to varying credentialing requirements state-to-state and, sometimes, payor-to-payor within the same jurisdiction.
Time is money in this case because the faster the provider is accepted into the network, the faster they will be reimbursed for services provided to patients. Without approval doctors and practices risk losing months of revenue.
Here are the top 10 most common enrollment mistakes we see.
#10 – Use the incorrect forms for the provider type – Similar acronyms and numbers on forms can make differentiation tough.
#9 – Use an outdated paper form – Easy enough, ensure you have downloaded the most recent form.
#8 – Submit an incorrect or incomplete application – We see it many times where a required form is mistakenly not included or a field is not completed.
#7 – Illegible handwriting, typos or hard-to-read copies – Even small mistakes can cause a major delay.
#6 – Missing cover letters or signature pages – Also, include the application tracking or document control number on these pages.
#5 – Expired supporting documents or incorrect data – Double check your own work for typos and incorrect info AND the work of others on supporting documents.
#4 – Inconsistency across legal documents and forms – Ensure the legal name on the application matches all legal documents such as IRS W-9, NPPES and licensee names.
#3 – Delayed follow up to payor requests – It is common to be asked for clarification, correction or additional information. Respond back quickly to ensure your application is processed.
#2 – Missing or incorrect signature – For paper application, check carefully whether a “wet ink” signature is required or if a faxed or stamped signature is acceptable.
#1 – Lack of communication about processing times to key stakeholders – Verify time frames with payors and communicate that with your provider to set accurate expectations.
Because the payor enrollment process is detailed and important, mistakes do happen. The key is to follow up and stay on top of the application throughout the process.
Donna is President of Team Med Global Consulting and a full time healthcare consultant, speaker, author and educator. With more than 40 years of healthcare
experience, her consulting work encompasses the entirety of provider management
and she served as President of the National Association of Medical Staff Services (NAMSS) in 2005.
