Payer Enrollment Basics & Avoiding Delays in Enrollment

Course Description

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:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and 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.

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com

Address:- 651 N. Broad Street, Suite 206, Middletown, DE 19709

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All tickets include recording of the event.