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Outsource Your Credentialing

Outsource your Credentialing and Payer Enrollments


"Why should we outsource our credentialing Payer Enrollment? “  

“Kim does all our Credentialing and Payer Enrollment in-house.  She's great!  She gets to it when she's not at the front desk, and when she's not working in collections.”  

“We had a couple of providers start 4 weeks ago.  Kim started the enrollment process, but we still haven't heard back from the insurance companies.  I wonder what the holdup is.  I bet Kim will follow-up as soon as she can.”   

“The problem is we haven’t been able to bill for any of the services those 2 providers have performed in the 4 weeks they’ve been here.” 

“And I don't know that Kim will have a chance to follow up with those Payers until maybe next week, since she is scheduled to work at the front desk the rest of this week. “ 

“I have too much to do to help her; and no one else in our Health Center knows how to do Provider Enrollment"    

Does this scenario sound familiar?  We witness similar situations daily.  It's no doubt that your staff is great, and that they are working hard to enroll your providers promptly and efficiently, but Payer Enrollment is a tedious and incredibly time-consuming process and it requires frequent and thorough follow-up. Unless you have a team that is strictly dedicated to your Credentialing/Payer Enrollment processes, consider partnering with someone who can do this for you; so that your front desk staff can focus on caring for your patients as they check in and out,  and so your billing staff can focus on collections.  Time is a precious commodity.  Being able to use it wisely is critical to your Health Center's success.   

When looking for a credentialing service to partner with for your Payer Enrollment needs, shop for a company that possesses qualities such as credibility, expertise, oversight, communication, and security.  

Credibility should be of upmost importance when shopping for a company to partner with to oversee and/or manage your health center's credentialing and enrollment processes.  Proceed with caution when sharing your facility and provider information, as when in the wrong hands repercussions can result.  Partnering with a company with whom you already have relationship is a great idea, since the connection is already there and most likely measures have already been implemented for communication, data collection, and so forth.  

Experience and knowledge go without saying.  If verification and enrollment is what you need; find someone with that know-how and those skills to deliver.  Credentialing is certainly not "rocket surgery," but it does take a partner with Credentialing and Payer Enrollment knowledge and skills with a whole lot of tenacity to perform the job effectively.    

Effective oversight of your credentialing is key.  From the verification process to enrollment and re-validation, it is important that the credentialing partner you choose is able to oversee and manage your health center's provider data and enrollment processes carefully and efficiently.  Accurate and complete enrollment applications are critical and frequent follow up with payers is necessary to ensure enrollment success.  After enrollment with a payer is attained, re-validation must be addressed on time moving forward to prevent leakage in revenue or gaps in coverage.  Additionally, oversight of expirables and other key data is crucial to compliance and mitigation.   

Communication is critical to the enrollment process and having a point of contact in your health center is a plus.  Your credentialing partner will need someone they can reach out to directly with questions, verification, and validations; additionally, the payer may request further information or documentation, due to ever-changing guidelines and requirements, which your facility will need to provide within a timely manner.  On the other hand, look for a company that will notify your health center routinely of status updates, as well as a company that will escalate needs to the next level should there be a break in communication.  A company that can keep in touch with you during the enrollment process is invaluable, as you will want to know when all the necessary data has been collected and verified; when the applications have been filed; when the payer has received the application with all necessary data and documentation; and of course, when enrollment has been approved!  Not to mention, it's helpful to know when there are problems or issues along the way.   

Security is imperative.  Data collection and documentation is the foundation for successful payer enrollment.  Enrollment can be delayed or declined due to missing or inaccurate information or documents.  Partner with a company who not only can work efficiently and thoroughly to collect your data, but one who can safely and securely store your information.  It is also important that you have access to that data, too, so that you can update it as necessary; and should your relationship with the credentialing vendor change, you'll want to make sure you will be able to retrieve your data.   

Aside from quality patient care, your bottom line should be your highest priority.  Revenue is vital to the Community Health Center.  It is necessary to use every resource wisely and effectively for the good, health, and well-being of our communities.   

Visualutions is excited to be able to offer this valuable service to you.   We are committed to providing your providers with the best credentialing care possible so that they can continue to provide the best patient care possible.  Let us work together to continue caring for the underserved.  For more information on how Visualutions can help you, click here.