7 Benefits to Outsourcing Credentialing and Provider Enrollment

Outsourcing credentialing and provider enrollment can reduce a provider’s workload, cost, and risk and increase provider resources, control, and peace of mind.

The credentialing and provider enrollment process is the process of enrolling providers with health plans and networks used. This process allows providers to begin billing patients for services.

Provider enrollment can be a lengthy, complicated, and often stressful process. A medical practice that performs the process in-house may make mistakes that can negatively impact the approval wait time and result in lost revenue. Therefore, accuracy is essential when credentialing and enrolling providers.

Outsourcing provider enrollment can help a provider achieve a quicker turnaround so that proper billing can begin. Medical practices can change how they do business when they outsource provider enrollment and reap the benefits outsourcing generates.

Seven benefits to outsourcing credentialing and provider enrollment include:

1. Reducing Workload
2. Reducing Costs
3. Reducing Risk
4. Increasing Resources
5. Increasing Control
6. Increasing Plan Options
7. Increasing Peace

1. Reducing Workload by Outsourcing Credentialing and Provider Enrollment

A healthcare provider must be credentialed before being placed on any health plan. Primary source verification (PSV) verifies a provider’s credentials – education, work history, licenses, and much more – to confirm the provider is appropriately qualified to practice medicine. This process involves a long and complex series of 52 conventional credentialing steps. Outsourcing the source verification process can reduce PSV from 52 down to just 6 simple steps. This aspect alone can streamline a medical office’s workload.

Instead of completing a separate application for every health plan a provider wishes to be enrolled in, a provider enrollment company like Primoris utilizing delegation can require only one application for multiple health plans and networks. Delegated contracts usually result in faster provider enrollment. A company like Primoris Credentialing Network can also enroll providers in non-delegated options more quickly due to years of experience and established relationships.

Having one point of contact can also reduce the time it takes to track down different people for information. Contacting one person to check the enrollment status on 10-20 plans can be a meaningful change. Outsourcing provider enrollment to a company that aims for administrative simplicity can free up more time to focus on more important work.

Another instance when outsourcing provider enrollment can reduce your workload is reappointment time. There is no need to dread this time because another team manages every reappointment.

2. Reducing Cost by Outsourcing Credentialing and Provider Enrollment

Performing provider enrollment in-office can quickly increase provider liability if unqualified staff oversee and fumble the process. Money a practice can lose due to the cost of increased liability can cut into profits. Lawsuits, late fees, and other potential fines can quickly add up.

Outsourcing provider enrollment to a team of experts whose focus is provider enrollment ensures accuracy and prompt billing. When the job is done right the first time, providers can begin billing faster and bring in revenue. Plus, time is money, and in-office staff must enroll providers on work time. Employees can spend this valuable time performing more essential tasks to improve a practice’s bottom line.

Furthermore, studies demonstrate that outsourcing provider enrollment can save a provider $29,000 annually. These cost savings can make or break a practice during these uncertain economic times.

3. Reducing Risk by Outsourcing Credentialing and Provider Enrollment

Provider enrollment is a meticulous job. One minor mistake and the entire process stalls or can completely derail. Not only can this cut into profitability, but it can cause avoidable complications that can reflect poorly on the practice and staff.

Experts specializing in provider data management are usually the most qualified to perform background checks and correctly complete health plan enrollment. Hiring experts to care for provider enrollment minimizes a practice’s risk and allows the process to be completed faster. The process generally takes 60-90 days – longer if mistakes are made.

Outsourcing provider enrollment can reduce the chances of this unfortunate occurrence, often typically completing enrollment in 30 days or less.

4. Increase Resources by Outsourcing Credentialing and Provider Enrollment

A provider enrollment company like Primoris can offer many resources to make the process as quick and painless as possible.

These resources can significantly streamline workflows and cut costs:

• An experienced team with 385+ years of industry experience.
• One point of contact for information.
• A secure web portal to manage and monitor the process.

In-office staff typically perform other job duties and cannot offer this level of resources consistently. A company focused on provider enrollment can provide superior customer service that you might not find elsewhere.

5. Increase Control by Outsourcing Credentialing and Provider Enrollment

Outsourcing credentialing can give providers access to more tools to help them increase positive control of their credentialing process. Tools such as a robust credentialing web portal provide access and control over all their credentialing data.

Using a web portal to manage and monitor the enrollment process can help ensure greater control.

An efficient, easy-to-use, and secure portal can allow users to:

• Track information related to health plan enrollment, including current statuses, reappointment filings, expiring documents, and more.
• Customize logins for administrators.
• Control reports are gathered from every piece of information.
• Access all data entered into the system, such as sent applications.
• Modify everything from rosters to enrollment requests.
• Upload and save documents in one place.

Healthcare providers and practices with more control over the process can feel better knowing that if an issue springs up, they can quickly investigate it and resolve it before it snowballs into something bigger. Providers can trust that their information is secure, not stuffed in file cabinets that anyone can obtain.

6. Increase Health Plan and Network Options by Outsourcing Credentialing and Provider Enrollment

Using a company like Primoris that offers 54+ health plans and networks can be a great boon come enrollment time. Practices can be prepared for clients to request plans they might not be enrolled in.

In addition, plan and network options tend to fluctuate. Primoris continuously expands its relationships to increase what can be offered to provider clients. When a new option is added to Primoris’ growing list, they are immediately communicated and available to their clients – sometimes before the market is announced locally.

Access to numerous plans and networks is just one more feature that can help enroll providers as quickly as possible, allowing faster reimbursement for their services.

7. Increase Peace by Outsourcing Credentialing and Provider Enrollment

Perhaps the ultimate benefit of outsourcing provider enrollment is the peace of mind that comes with handing the burdensome job to someone else. You can eliminate the stress of managing every minutia of the process. Practice staff can focus on what they are best suited and trained for while skilled professionals undertake enrollment duties.

Knowing providers will be efficiently enrolled in plans or networks can reduce financial fears. A practice facing cutbacks or worse can worry less. Their providers can bill as soon as they are enrolled.

Outsourcing provider enrollment is a wise business decision. This simple action can reduce a provider’s workload, cost, and risk while increasing a provider’s resources, control, health plan options, and peace of mind.