Payer Enrollment Basics & Avoiding Delays in Enrollment
Payor enrollment is a time-consuming process that creates barriers to practitioner onboarding and revenue generation. Payor enrollment can delay the onboarding process for months, especially with commercial payors. These delays create issues with provider satisfaction, patient satisfaction, revenue generation, access to care and, ultimately, patient safety.
This presentation will review the process for enrollment with government and commercial payors, discuss the most common reasons for delays in payor enrollment and steps to take to avoid those delays.
Learning Objectives
Define Payer Enrollment
Describe the Process for Enrolment with Government and Commercial Payers
Discuss Most Common Reasons for Delays in Payer Enrollment
Review Tips to Avoid Delays
Understand Timelines Associated with Government and Commercial Payer Enrollment
Identify the Role of CAQH in the Payer Enrollment Process
Gain Familiarity with PECOS Registration and Functionality
Recognize the Impact of Payer Enrollment Delays on Revenue and Provider Satisfaction
Understand Key Compliance Considerations Related to Payer Enrollment
Review Commercial and Government Plan Requirements in the Enrollment Process
Areas Covered in the Session
Definition of Payer Enrollment
Timelines for Government Payers
Review of Federal and State Plan Guidelines
PECOS History and Overview
Registering for PECOS Access
Most Common Reasons for Delays with Medicare Enrollment
Tips to Avoid Delays
Timelines for Commercial Payers
Commercial Plan Types and Requirements
CAQH role in Payer Enrollment
Commercial Payer Enrollment Process
Live Q&A Session
Suggested Attendees
Payer Enrollment Specialists
Payer Enrollment Supervisors and Managers
Revenue Cycle Personnel
Credentialing Specialists
Medical Staff Coordinators
Medical Practice Administrators
CVO (Credentialing Verification Organization) Staff
Healthcare Compliance Officers
Managed Care Coordinators
Provider Relations Managers
Practice Managers and Office Administrators
Billing and Reimbursement Specialists
Revenue Integrity Analysts
Quality Improvement and Regulatory Professionals
Healthcare Consultants Supporting Credentialing and Enrollment
Health Information Management (HIM) Professionals Involved in Provider Data
Group Practice Executives and Administrators
Hospital Credentialing and Enrollment Teams
Provider Network Managers
Contracting Specialists in Managed Care
Anyone Involved in Provider Onboarding, Enrollment, or Payer Communications
About the Presenter
Tammy is the Senior Director of CVO Operations and Regulatory Compliance with The Hardenbergh Group. She brings 25 years of experience in healthcare administration and 18 years in Medical Staff Services. She specializes in CVO operations, provider credentialing, provider enrollment, quality analysis, quality improvement, quality auditing, delegation audits, and policy and procedure creation and implementation. She has extensive experience with CMS, TJC and NCQA requirements for provider credentialing and medical staff services.
Tammy leverages her vast professional experience to help clients assess and improve operational efficiency, prepare for regulatory surveys and audits, pursue NCQA accreditation and certification, and more.
Tammy has a master’s in healthcare administration with a minor in Education and a BS in Human Services Management. She is a member of the North Carolina Association Medical Staff Services and the National Association Medical Staff Services.
Additional Information
System Requirement:
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly
Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.
For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com