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Starting Up Your Enrollment Operation February 11, 2015 Donna Goestenkors, CPMSM and Dina Solis 1.

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Presentation on theme: "Starting Up Your Enrollment Operation February 11, 2015 Donna Goestenkors, CPMSM and Dina Solis 1."— Presentation transcript:

1 Starting Up Your Enrollment Operation February 11, 2015 Donna Goestenkors, CPMSM and Dina Solis 1

2 Session 2: Starting Your Enrollment Operation 2

3 Donna Goestenkors, CPMSM +Team Med Global Consulting, LLC 3

4 Dina Solis, Owner +Sonoma Credentialing Services 4

5 OBJECTIVES Walk through Payor Enrollment application elements and process. Learn Enrollment success tips. 5

6 PREPARE YOURSELF “You can’t make positive discoveries that make your life better if you never try anything new.” ~Josh Kaufman, Author & Business Advisor 6

7 Payor Enrollment Enrollment is the process of applying to health insurance plans/networks for inclusion into provider panels to bill and be paid for services rendered. 7

8 TYPES Federal & State Private & Commercial Worker’s Compensation 8

9 Two Steps Pre-Enrollment Post-Enrollment 9

10 What is the Process? Pre-Enrollment +Step 1 – Determine Which Plans to Enroll. +Step 2 - Collect Provider Info & Documents. +Step 3 - Obtain, Complete & Submit Application. +Step 4 – Follow up Until Determination is Made. 10

11 Pre-Enrollment Step 1 – Determine Which Plans to Enroll +Pre-determined based on group/hospital etc.? +If not, resources (AIS Directory of US Health Plans). +Go to payor’s website, call Provider Enrollment for enrollment timeframe, any special requirements or forms, and preferred submission method/address. 11

12 Pre-Enrollment Step 2 – Collect Provider Info & Documents +Pre-application, CAQH, NPI registry, repository. +Review/QA for completeness/accuracy. +Check addresses, zip codes and counties on USPS website. +Check names/addresses/expiration dates on licensure and supporting documents. 12

13 Pre-Enrollment Step 3 - Obtain, Complete & Submit Application Application Elements +Instructions (great reference for most questions!) +Provider Identifying Information, Education, Training +Provider Licensure, Certifications, Affiliations +Provider References & Work History +Practice Information/Description/Services +Professional Liability Insurance 13

14 Pre-Enrollment Step 3 - Obtain, Complete & Submit Application Application Elements (Continued) +Billing Info/Clearinghouse/3 rd Party Administrator +Attestation Questions/Disclosures +Ownership/Controlled Interest Disclosure +Information Release/Acknowledgements +Provider Agreement(s)/ EFT Agreement +Checklist of Attachments 14

15 Typical Application Attachments Required +All applicable Professional, Medical, Federal, State, & Local Licensure, Certifications, Registrations. +IRS Issued CP575 & Signed/Dated IRS W9. +Articles of Incorporation/Partnership Agreement, etc. +Professional Degree, Fellowship, Residency, CEU, DL/Pic. +Professional & General Liability; Workers Comp (if app). +Copy of Voided Check (for EFT agreement). +Copy of Lease Agreement for Practice Location (CA). +Application Fee (if applicable). +Cover Letter (paper applications only). 15

16 Pre-Enrollment Step 4 – Follow up Until Determination is Made Communication, Communication! +Follow up with payor ( , phone, fax). +Respond promptly to any requests for more info. +Give updates to provider or supervisor/log into system. +If approved, you may need to ask for an acceptance/welcome letter, or duplicate letter. +If denied, ask why and when to re-apply. 16

17 What is the Process? Post-Enrollment +Step 1 – Obtain Proof of Enrollment/Denial. +Step 2 – Implement with Billing Department. +Step 3 – Record/Load New Contract in Database. +Step 4 – Maintenance for Continued Enrollment. 17

18 Post-Enrollment Step 1 – Obtain Proof of Enrollment/Denial. Step 2 – Implement with Billing Department +Assist with any applicable EFT, EDI, ERA paperwork. Step 3 – Record/Load New Contract in Database +Executed copies; welcome letter; ensure provider is loaded into payer network system. Step 4 – Maintenance for Continued Enrollment +Send any changes/updates/lics. to payer; re-attest. 18

19 Success Points +Begin the enrollment process immediately upon colleting provider’s information/documentation. +Automate the enrollment process to the greatest extent possible with credentialing software. +Lessens errors & omissions. +Minimize the use of paper forms whenever possible. +Expedites process with some payers. + Respond to payor requests as soon as possible. + Communicate proactively with providers! 19

20 POWER THOUGHT “Your resources are always far greater than you imagine them to be. Never ask, ‘Can I do this?’ Ask instead, ‘How can I do this?” ~Dan Zadra - Author 20

21 And now, a word from our sponsor… Provider Credentialing From symplr (formerly Medkinetics) For the person who wants to DIY the enrollment process Provider Credentialing provides: – Dynamic Payor Enrollment forms – Enrollment status tracking logs – Enrollment reports For more information 21

22 Q&A Ask your questions in the chat box and we’ll get right to you If we don’t get to your question during this session, someone will follow-up with you after the session! 22

23 Save the Date: Enrollment Series Session 3:“Running a Successful Payor Enrollment Operation” Wednesday, March 11, 2015 Noon – 1:00 p.m. CST 23

24 Speaker Contact Information Donna Goestenkors, CPMSM +Team Med Global Consulting, LLC +Telephone: (618) Website: +Like Me: +Connect with Me: +Follow Me: 24

25 Speaker Contact Information Dina Solis, Owner +Sonoma Credentialing Services +P.O. Box Petaluma, CA Telephone: (855) Website: +Like Me: +Connect with Me: 25

26 Credentialing Tool 26

27 The Medical Services Professional Career Guidebook Features include: +Frequently asked career questions by MSPs +Sample job descriptions, career assessment tools, competency development plans and more +Real-life stories to illustrate career decisions +Purchase today or order your copy: 27

28 28

29 Team Med Global Newsletters & Blogs 29

30 Thank You! 30


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