Payer Enrollment in 2023

Effective physician onboarding is a process that requires an organized approach to the many details that play an essential role in your practice’s financial success. Front and center in that process is provider enrollment in payer plans. Accurate and timely provider enrollment is the first step and is key to successful revenue cycle processes. Initial enrollment and recredentialling with payers is an annual process for most practices and it remains an ever-evolving landscape. Many payers change forms and needed information over time. Missing a key step or required piece of information may put your revenue cycle efforts at risk. 2023 is no different, as CMS is making changes in the PECOS enrollment process. Provided below this article is a link to a YouTube video published by the CMHSHHSgov channel explaining PECOS 2.0 changes.

As a reminder we have provided the below list of key steps to keep in mind as you navigate this process.

• First and foremost, the beginning of the enrollment process is to verify the existing or establish a new entity with regard to each group expansion, merger, service line addition.
• Don’t let a lapse or missing documents be the cause for an enrollment failure.
• When to start? The day a decision is made to grow or make a change, where a provider is identified with a start date.
• Don’t let outdated or missing documents hold up your process. Verify the availability of each required document at the beginning. There is no time for delays.
• Be sure that the provider has documentation and a timeline that includes all years of clinical practice activity.
• Documents will need to be accessed, sometimes more than once in the process, so everything should available electronically.
• Never assume that documents or processes followed in the past are relevant in the present. Get updated process information for each enrollment directly from a website or resource within the payer organization.
• Get any information from providers that have experienced reportable actions with organizations in the past. These events could add months to an enrollment process.
• Enrollment processes can change by payer, by state, and by service line.
• Use a review process before anything is sent to a payer. That redundancy in the process can potentially save months of frustration.
• The process ends when the payers recognize an active network status, and claims are processed by EFT directly to your bank account.

The above are just a few of the reasons that credentialing services are highly advised. As in our case, our team is focusing on payer enrollment every day, have familiarity with the payer processes, and use technology to organize our provider data for present and future access for all validation processes.