The COVID-19 pandemic, a global nightmare that has hit the U.S. especially had grim statistics that speak volumes are indicative of, so to do the life-threatening challenges that overburdened healthcare organizations are now facing as the COVID-19 runs its course. Hospitals are packed beyond capacity with patients now needing to be treated at emergency makeshift facilities. And while Providers on the front line deal with life-threatening situations, this crisis will no doubt impact how Provider and Payer organizations must react to all the more critical demands to credential Providers and enroll them into health plans.

Although working to ensure that the care and treatment of victims of this pandemic is now paramount, ensuring that Providers and Provider organizations get timely and accurate reimbursements must also be addressed. The bulk of the burden of these administrative challenges will almost certainly fall on the shoulders of Payers’ and Providers’ administrative operations.

With many medical professionals now working 24x7, emergency patient admissions are increasing at unsustainable rates that are causing severe shortages of Provider staff while also jeopardizing the safety of our healthcare professionals. There is now an exploding demand for additional Providers that are and will be sorely needed to fight this and future recurrences of this type of crisis. A spotlight will therefore almost certainly be placed on ensuring an organization’s ability to onboard, credential and enroll Payers into plans is up to the task. Payers will also be facing similar challenges, which will include the ability to quickly build and maintain quality networks. Unfortunately for many Provider and Payer organizations, there is a reliance on infrastructures and business processes that are outdated, difficult to scale and already posing operational challenges that this pandemic will only further worsen.

These are unprecedented times for Provider and Payer organizations, which will require more efficient and timely enrollment, privileging, credentialing and network management capabilities. This Pandemic will almost certainly be a driver that will require organizations to modernize their systems and business processes to better ensure readiness in the event of future similar crises.

Fortunately, in the short term, CMS has made several announcements regarding the lifting and loosening of various regulations to allow Provider and Payer organizations to better deal with these unprecedented times. Examples of COVID related guidance include temporary leniency for compliance regulations and facilitating timely if not immediate reimbursement of funds to Providers and Provider organizations, providing out of state license to Providers, and postponing practically all steps that slow down critical processes. Payers and Providers should therefore start to proactively enhance, streamline and strengthen Provider management capabilities wherever possible.

Santech Is Ready To Assist

Santech stands at the ready to assist customers and prospects determine how best to face these unprecedented challenges. By appropriately leveraging technology, resources, and subject matter expertise to minimize, automate or eliminate inefficient processes while also streamlining enrollment, privileging, and credentialing capabilities.

Santech remains committed to continue working with healthcare organizations at their pace and convenience as it understands what they’re going through.

To ensure smooth Provider management, Healthcare Providers must keep up with the constantly evolving requirements surrounding Provider enrollment and credentialing processes. It’s essential to running a profitable practice and providing quality healthcare facilities. However, credentialing can be a little challenging, complex, and seriously time-consuming, especially if it’s managed manually.

From Provider credentialing to health plan contracting, Payer enrollment can take as long as 90 to 180 days to complete. And for some health plans, Payer enrollment may take even longer. For example, healthcare organisations may be waiting up to 180 days for Medicare to verify a Provider’s credentials and approve their participation in the federal healthcare program. If every month enrollment is delayed, health systems and practice groups can lose an average of $100,000 for a single primary care Provider. For speciality care, the losses are even more staggering at approximately $300,000 per physician every month.

Waiting months to receive a health plan’s stamp of approval may be hurting care access, especially in light of the recent physician shortage. The Association of American Medical Colleges (AAMC) projects the healthcare industry to face a critical shortage of 122,000 doctors by the end of the next decade.

The Existing Payer Enrollment Situation

Payer Enrollment is the initial phase in the Payer-Provider relationship. Without it, Providers can’t start to bill for administrations or be paid in a timely manner, so they should commit a lot of assets to finish the enrollment procedure.

With every Payer requiring explicit forms, sent in specific arrangements, and with those forms regularly filled manually, it’s a dull task that requires a significant amount of time for physicians and their staff. There are various steps involved in the process that must be redone for each new Payer-Provider relationship, and steps frequently must be repeated even for a single Payer due to frequent updates and errors.

While rounding out forms and agreements may appear to be a basic regulatory undertaking, the absence of consistency in the procedures utilized by Payers, clearinghouses and other outsiders leaves open doors for errors. In most of the cases, Payer Enrollment comprises these eight steps:

● The Provider starts the credentialing procedure for new clinician.

● Provider communicates to the Payer that they are keen on credentialing.

● Providers manually fill up various kinds forms.

● Payer gets a Provider’s application.

● The 90-day-in survey process starts.

● Payer plays out a different and distinctive confirmation.

● Payer acknowledges Provider application.

● The procedure repeats for two-three years to follow the National Committee for Quality Assurance (NCQA) credentialing norms.

The end-result of such a drawn-out procedure is a divided framework with absolutely no specific characterised responsibility of the data and different roles included. The manual errands engaged with the procedure likewise forestall smooth exchanges, from the requirements for “wet signatures” to the utilization of snail mail to submit contents. The aftereffect of those components is the expanded risk of “terrible information,” which further confounds the procedure by making irregularities and redundancy. Also, with no single source of truth to fill in as a definitive asset, errors keep on accumulating, costing more money and time.

Now let’s take a look at these key challenges separately that dampen the credentialing process

● A fragmented data that is pulled in all directions and verified multiple times by different sources

● In reference to the point aforementioned, a constant confusion arises as to who actually owns the data- is it the organisation staff, verifying offices, or the smaller third-party Payers.

● It’s a cumbersome manual process. As a matter of fact, even today almost 83% of all the credentialing processes are carried out through papers and mails. This makes it a high-risk endeavour.

● The constant change in data address, multiple alterations, it all contributes to an inconsistent management.

Despite the availability of apps such as CAQH provided by different institutions and state authorities, the problem of delayed credentialing does not seem to be going away.

However, the coming innovative automation has proved to be the only stand-out solution that is truly influential and helps organisations save millions of dollars. Let’s move on to the next section to explore more about it.

Fixing the Problem

The frequent inefficiencies, fragmented data, and management issues with the Payer enrollment process is something that almost every organisation and healthcare professional would identify with. So, a robust Provider data management solution is indeed required to alleviate these challenges.

I-Enroll, a premier Provider data management platform from Santech Solutions puts Provider recruitment, Provider credentialing, Provider privileging, Provider re-appointments, and Payer enrollment processes under one umbrella. It shortens Provider on boarding cycles, resulting in more timely revenue recognition.

It automates preparation and assembly of Payers application and follow-up proactive notifications on re-cred coming due. The I-Enroll Provider data management lowers expenses associated with credentialing and privileging activities and supports seasonal spikes in on-boarding and re-credentialing volumes.

I-Enroll strengthens and streamlines organisation capabilities for delegated and non-delegated contracts. It automates the upkeep and tracking of enrollment application status by Payer, Provider, and Location. The I-Enroll Provider data management proactively tracks and screens Provider for re-enrollment. It automates and flawlessly coordinates to third party information for administration services. It also responds quickly to the adjustments in guidelines that sway Provider information management. In general, I-Enroll lessens the Provider’s disappointment due to a wasteful procedure.

The convenient enrollment of Providers into healthcare plans has become a significant prerequisite for supporting a flourishing practice. Santech’s I-Enroll can assist you with diminishing the administrative work issues, streamline your Provider on-boarding procedure and boost up the revenues of your organisation.

Conclusion

The Healthcare industry is undergoing a massive transformation for Providers and Payers, who are determined to add more value to their business by providing the best facilities for their patients. To deliver such goals a substantial modification, of both revenue models and technological faculties, is taking place.

I-Enroll is a classic example that integrates innovation and technology to bring together a sophisticated software for better Provider data management. It provides a personalized credentialing solution with comprehensive end-to-end functionality that takes care of all elements of data management.

The solution intelligently automates Provider directory updates that sends automated directory responses to Payers without any manual interventions. This eliminates the painstaking task of making repeated inquiries and updates. So by removing the burden of unnecessary fact-finding and other administrative tasks from the staff members, it reduces the risk of inconsistencies and manual errors, and also the dependency on human efforts.

I-Enroll also ensures Provider directories are updated automatically as per their state-authorised regulatory period. It saves you from the trouble of managing numerous Provider directories with different scheduling.

I-Enroll promises faster enrollment and faster credentialing through an incredible data management experience and helps organisations provide only the best healthcare facilities to their beneficiaries.

I-Enroll.com, an intuitive platform for small and solo practices, can help unravel the complex process of Provider credentialing and the delays with enrolling medical and dental Providers in Payer networks. The process includes:

• Requesting participation in a Payer network.





• Completing credentialing requirements.





• Managing documents in a central hub





• Submitting forms to the Payer.





• Continuous follow-ups





• Managing contracts, documentation, and renewals





• Responding to directory update requests and proactively offering updates

Why Do You Need I-Enroll.com?

Healthcare practices must ensure Payer enrollment is completed speedily and accurately for each Provider to get paid for rendering services and proactively schedule patient services. Failing to meet the Payer enrollment process will lead to on-hold claims — and in few cases, claim denials.

But perfecting Payer enrollment is a usually long and arduous process for practices. Further, the need to streamline and improve the function increases as Providers face an increasingly competitive marketplace.

As practices find their Provider workforce frequently changing, medical service staff find it challenging to adapt to the changes. As a result, the organization’s bottom line may suffer due to more claims being put on hold.

For small and solo medical and dental practices, I-Enroll.com allows to: -

• Get Rid of Credentialing Paperwork





• Keep All Credentials in a Central Hub





• Staying proactively informed of any expiry





• Enroll in Health Plans Faster and Stay Abreast Of Re-Enrollment





• Staying updated with Payer directories

Paperless Credentialing

I-Enroll.com allows you to upload all your Provider data and credentials online without manual efforts for hassle-free credentialing.

E-signature and Unlimited Payers Form Mapping

Every second count in healthcare facilities, and at times, anticipating specific signatures or medical consent forms can prove expensive. I-Enroll.com allows for e-signature and electronic forms that can considerably help healthcare professionals. I-Enroll.com also offers instant access to all significant Payer forms in digital format. Unlike CAQH’s “free” service, it generates and comprehensively prepares application packets according to individual Payer requirements.

Effortless Centralized Document Management

I-Enroll.com provides a secure, easy-to-use, but intelligent “online file cabinet” that stores and protects all essential documents. It automatically notifies upcoming expirables, application status and more, so that you never miss a deadline again. You can also audit document history with I-Enroll.com.

Built-In Tracking System

It helps you track application status in real-time and ensure that they are successfully submitted per Payer requirements.

Alerts on Upcoming Expirables

I-Enroll.com facilitates automated monitoring and notifications of upcoming expirations and re-cred statuses.

Benefits: -

• Streamlines Payer enrollment to save time and money





• Faster reimbursement





• Covers all significant Payers with the most comprehensive Payer form library





• Additional Payer forms are added at no cost





• Navigates Payer rules and requirements





• Keeps small practices on top of their credentials





• Manages and protects the information





• Staying abreast of re-enrollment

Tap into I-Enroll Network — A Modern Payer & Provider Network

1. All Participating Payers Will Get Your Updates Automatically.

Using I-Enroll.com radically reduces the time spent to update Payers with your practice’s latest information. Connected to the I-Enroll network, your data always stays current — no peskier requests for Provider directory updates!

2. Payers will communicate their credentialing and re-credentialing requests to you online.

You will never get dropped from a network without your knowledge

3. Payers will recruit you online.

You will receive notification alerts of recruitment interests when Payer expands networks. Providers no more need to perform back and forth phone calls and fill out lengthy applications.

In its essence, I-Enroll.com opens and facilitates communication between Payers, Providers, and Practices and ensures enrollment is approved and stays approved. With a clearer and efficient Payer enrollment process, practices will notice an increase in their claims paid timely with fewer complex operations.