Payor Enrollment

Issues & Solutions for Payor Enrollment and Licensing Delays

As the COVID-19 pandemic rages on, provider practices continue to face unprecedented challenges and pressure in finance and operational areas. A rocky 2020 has disrupted the normalcy of healthcare administration, leaving many scrambling to adapt to new healthcare delivery and communication modes. A priority for 2021, is to properly plan for the ability to regain stability.

The first step in the revenue cycle for most practices is provider enrollment with insurance payors. Proper and timely enrollment ensures that providers receive payment for the care they deliver. While the process itself hasn’t changed very much compared to previous years, the actual practices may catch you off-guard with delays and issues related to remote working conditions.

Delays in application delivery, processing and troubleshooting

We have noticed that since the outbreak of COVID-19, there has been a significant delay in application processing and many payors are unable to meet their published turnaround times. In many cases, providers cannot obtain anticipated enrollment approval dates from payors, resulting in onboarding delays for newly hired providers and disruption in practice operations. Requesting the backdating of the provider’s effective date is not a reliable solution to the issue of delays between the date of hiring and the first date of service to patients.

Another change resulting from the pandemic are the remote working conditions on the payor’s side. As application processing and support agents move to work remotely, providers have experienced a drastic increase in wait time for follow-up calls and call lengths. Also, remote insurance payor employees cannot effectively escalate issues to internal management teams and coordinate cross-department solutions. Therefore, providers can expect extra delays should their applications run into problems that require troubleshooting or extensive analysis from payors.

Since the beginning of the COVID pandemic, many states have suspended rules requiring an in-state license to provide care to support the needed expansion of telehealth. State medical boards have allowed providers to work with either a temporary license or no in-state license at all. While there is a growing call to reform the medical licensing process, for now, these relaxed regulations will only last until the COVID emergency status is lifted. At that point, many providers will be applying for full licenses alongside new graduates. This means an increase in the workload at the state levels and potentially results in even further processing delays and disruptions.

The most unexpected issue with enrollment applications is the actual delivery of paperwork when required. The US mail system has undergone severe delays and sorting issues due to social distancing and quarantine requirements. As a result, we have seen an increase in delivery delays for applications that required ink signature (compared to an electronic one). Late delivery of applications and other paperwork may cause downstream processing issues, putting your reimbursement at risk.

Strategies to navigate these issues:

A good strategy to navigate this changing landscape is to keep yourself informed and updated on requirements and processes of the payors you intend to enroll with. Practices may work with a dozen payors at once, and the lack of standardized enrollment processing puts the responsibility on providers and practices to keep up with changes.

Routine research on provider enrollment requirements for your payor base can help you avoid common mistakes and issues that can slow down your applications. A few payors have made changes to prior enrollment requirements due to the pandemic. For example, they may no longer require ink signatures or have created temporary and fast-tracked enrollment processes to prevent application backlogs.

Another strategy you can adopt is to plan for new hires and collect all necessary enrollment documents during your onboarding process. Allowing ample time between the hire date and first date of service will lower your risk of revenue loss by giving payor staff enough time to process enrollment applications.

Staying on top of all these changes can be incredibly difficult and costly for provider practices yet are essential to maintaining a seamless operation. Outsourcing these functions will allow practices to save time, money, and effort. A vendor skilled in payor enrollment and state licensing can handle every step of your needed processes and follow through with all requirements so that you can focus on doing what matters: delivering quality care to your patients!

In most cases, outsourcing is more cost effective for a practice than doing it in-house. Given the reduction in reimbursement from Medicare in 2021, this decision can directly impact your practice income as well. By providing a streamlined payor enrollment or licensing process with visibility across the board, management service organizations like Saisystems Health can help you have your claims paid on time and without complications.