Payer Enrollment Software Essential Features

IN A NUTSHELL:

• Payer enrollment software features are as important as credentialing
• Proper software will allow for quicker reimbursements
• E-signatures, automated data population among essential features

Similar to credentialing software necessities, payer enrollment software has its own list of essential features to reduce administrative burden and help physicians and medical facilities receive reimbursements as quickly as possible.

The importance of credentialing is a given and most are familiar with the process and how cumbersome it can be. The same is true for payer enrollment.

Payer Enrollment Integrated With Credentialing Software:  

Ideally, payer enrollment should be automated and integrated with a credentialing software. Manually submitting applications for providers to payors is a time-consuming process that can create an administrative burden for staff and potentially lead to a delay in reimbursement or missing out on treating potential patients.

If a provider doesn’t get paid, the facility doesn’t get paid. If the facility doesn’t accept the preferred insurance plan of a patient, they lose out on providing care for a patient and the potential to build upon their customer base. Since much of the provider data would already be stored in the credentialing platform, there is no duplication of collecting information or waiting for providers to respond to requests for information.

Auto-Populating Payer Enrollment Applications

Another essential feature for payer enrollment software is the ability to populate digital forms with provider data. This feature goes far beyond its utility for payer enrollment, as it can be used for a number of applications necessary to maintain compliance, such as license renewal. With respect to payer enrollment, this feature is a no-brainer. The application forms can range between 25 pages and 54 pages in length. The time it takes to manually complete the entire process could be up to 90 days.

If a health care provider wants to enroll in Medicaid, the process is similar but slightly more complex since the program is administered by the state but partially funded by the federal government. Thus, it is important to note that enrollment in Medicare does not guarantee enrollment in Medicaid. Consequently, a provider must re-enroll in Medicaid each time they choose to move or practice in a different state. The Centers for Medicare and Medicaid Services (CMS) provides oversight for each state to adhere to federal regulations for enrolling providers in Medicaid, Medicare, and Children’s Health Insurance Programs (CHIP). The ease of the enrollment procedure can directly impact the number of patients a health care worker can treat on a routine basis, which in turn affects the amount of revenue produced for a facility. No matter the level of care administered by the provider, personal connection and trust bestowed in them by the patient, or longstanding history of treatment; the rising cost of healthcare ultimately the decision of where to seek care will be based upon acceptance of health insurance plans.

The greater number of health insurance plans offered by a facility results in a more extensive opportunity for patients to obtain services. Automatically completing digital applications is an essential feature for any payer enrollment software and ultimately benefits patients, providers, and facilities.

Electronic Signatures

While some credentialing software solutions may have a feature to populate digital forms, it is pointless without the ability to swiftly finalize the process using an electronic signature. Many credentialing software solutions will populate an application with a provider’s information yet leave it up to the administrator to print out the document and wait for a physical signature to complete the process. Aside from all of the time lost waiting for a health care provider to interrupt patient care time to spend on administrative tasks, switching from digital to physical documents opens the door for mistakes.

CAQH Database

The Council for Affordable Quality Health Care, also known as CAQH, is a nonprofit alliance of health insurance plans and trade associations. There are a few steps involved with a health care provider’s information becoming a part of the CAQH database.

Typically, a health care provider requests participation in a health insurance plan or network that accepts a CAQH application. The health insurance plan creates an online account for the provider. Then, the application is completed and submitted to CAQH along with several other supporting documents—all online. Once the application is completed, any insurance company that accepts the CAQH application can access the provider’s data, which in turn expedites the enrollment process.

However, the process does not end there. Approximately every two months the healthcare provider’s information needs to be updated. Many health insurance plans are signing on with CAQH. It is essential for a medical facility to have the ability to easily upload information into the CAQH database, which allows them to access multiple plans at once and submit a single application for a provider to all of the chosen insurance plans.

This will save a health care facility time, money, and increase the efficiency of the enrollment process and allows a provider to stay in-network with minimal work. It is essential feature for a software to bridge the gap between credentialing a provider for a facility and uploading all of the provider’s data and information into CAQH. If a provider is credentialed for a facility, health care administrators should be able to export all of the provider’s data into a single document and access their CAQH account to populate the provider’s profile with their verified data and information.

Payer Enrollment Tracking

 Taking into account all of the administrative efforts that are a part of the payer enrollment process, making sure enrollment is completed and up to date is essential. Enrollment software should allow administrators to be able to see all of their providers as well as their status with any specific insurance network. Administrators need to be able to automatically connect with any specific insurance plan needed for individual providers. Without this feature, the facility and provider are at risk for either not receiving reimbursement for services or losing a potential patient.

Ready Doc™ by Intiva Health

Ready Doc™ is a credentialing and compliance platform which also offers payer enrollment features. Within the same dashboard where provider credentialing, privileges, and appointments are completed, administrators are able to complete payer enrollment as well. Ready Doc™ offers all of the essential payer enrollment features listed above and more. As a credentialing platform, automated provider and payer enrollment can be easily executed since the data is already stored in a central repository. With an extra layer of security through Hashgraph-based distributed ledger technology, health care providers and medical facilities can rest assured all of the provider’s information is secure yet easily accessible. The solution is a win-win for providers, patients, and facilities! The credentialing process is fast and hassle-free. With our credentialing software, providers can start treating patients sooner, revenue is boosted, administrative work is reduced, and there is more time for patient care.

To learn more about how your facility can be ready with Ready Doc™, schedule a FREE demo online today or call 844-413-2602.

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