Delegated Enrollment: The Faster, More Efficient Provider Enrollment Solution

Establish delegated health plan contracts to streamline and accelerate enrollment.

Establish delegated health plan contracts to streamline and accelerate enrollment. 

Provider enrollment has a significant impact on your healthcare organization’s revenue cycle. When healthcare providers are not enrolled properly with one or more health plans, or if they have accidentally allowed their enrollment status to lapse (by missing a re-enrollment/revalidation deadline), billing disruption is inevitable. Every month enrollment is delayed, healthcare organizations lose an average of $100,000 for a single primary care provider and $300,000 for a specialist.

Non-delegated provider enrollment is time- and labor-intensive for both the healthcare organization and the health plan. When a provider enrollment request is initiated, the healthcare organization gathers the required documentation and signatures and submits a unique application for each provider to each health plan. The health plan then performs its due diligence by verifying the provider’s credentials, a process that can take up to 180 days to complete, and is often performed manually. Meanwhile, staff must continuously follow up with each health plan by phone or by checking the health plan’s website/directory until participation is confirmed. After a provider is enrolled in a health plan, the provider must be revalidated and re-enrolled as often as the individual health plan requires, in accordance with its governing body regulations.

RELATED EBOOK: The Invisible Impact of Credentialing and Payer Enrollment

Delegation—a regulated process by which a health plan grants a healthcare organization the authority to perform a contractually defined set of credentialing functions on its behalf while maintaining oversight of the proper execution of these functions—has emerged as a panacea for several issues encountered during the enrollment process. In fact, delegated enrollment significantly speeds up the enrollment process—from 180 days to only 30–45 days—as the manual effort of verifying provider information no longer needs to be performed by the health plan. Once a new provider joins a healthcare organization and passes the credentialing process, the Provider Enrollment department submits all pertinent information on a single, health plan-specific template (the health plan roster), eliminating the administrative burden of acquiring signatures and completing many cumbersome applications.

Just as health plans have different rules and requirements for manually enrolling new providers, updating information for current providers, and terminating providers no longer with your organization, there are also rules pertaining to delegation. Specific roster formats, pending prerequisite health plan enrollment (for Managed Medicare and Medicaid), and timing of submissions are all examples of Enrollment Methodology. The rules that are shaped from the terms of the delegated contract must be incorporated into your processes to ensure compliance standards are being met. Provider enrollment software that can be loaded with the Enrollment Methodology offers a facilitated and automated approach to quality control.

Ultimately, with a delegated health plan contract, organizations can submit new, existing, and terminated providers on a single roster. The health plan notifies you when the process is complete, so you don’t have to call repeatedly to obtain status updates. Roster reconciliation is simplified with a one-to-one match of rostered information, providing substantial control over quality provider data. By converting to a delegated model, healthcare organizations and health plans realize unparalleled improvements in the processes that govern the growth and representation of their network, shorten turnaround times for network participation, enhance provider experience, and expedite access to revenue.

TractManager’s Delegated Enrollment solution reduces enrollment timeframes from 120–180 days to 30–45 days, minimizes the administrative burden for providers and staff, promotes data integrity through dynamic data validation, and improves revenue cycle management. CARE, our robust credentialing, privileging, and enrollment software solution, automates delegated roster creation and maintenance, data validation, and reconciliation of provider data with health plans for accuracy. To learn more about delegated enrollment, read The 4 Ds of Provider Onboarding Guide.

Author:

Allyson Schiff

Senior Director, Strategy & Growth, Provider Management

Allyson Schiff joined Newport Credentialing Solutions in 2009 and joined TractManager when Newport was acquired in 2018.

 

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