As one can see, delays in payer enrollment and credentialing is an expensive problem that healthcare providers cannot afford to make when they are already facing staffing wage increases, higher inflation rates, and denials on the rise.
The reality is that getting to participation status takes time, and payers cannot be rushed. A typical provider contracts with 20-25 payers annually, so think about the total amount of time this entire process takes per provider. While there are many steps that can be taken to streamline the payer enrollment process, payers have their own lengthy process that must be completed before they can accurately credential those providers.
Be aware of these key points to realistically align expectations:
- Insurance payers have their own timeline and workflow they follow
- Once the payer application has been submitted, it’s out of your control
- Complaining to the payer does not help speed up the process
- Some healthcare organizations have reported not receiving an effective date after their providers were enrolled
There are some instances where a provider can bill retroactively for their services before they are fully credentialed and enrolled, but it is important to find out which payers allow this and which do not. Do not assume it is allowed.
Below are the typical timelines for provider administrative teams to complete each of the following payer enrollment tasks.
Typical Provider Administrative Timelines:
- State Licensing: 3-6 months
- Credentialing: 4-6 months
- Payer Enrollment: 4-6 months
- EDI Enrollment: 3-5 months
- CME management: continuous
- Management of Directories: continuous
These are all painful tasks that have to be done continuously. If an individual handling these tasks makes an error in state licensing for example, their timeline could now jump to 9 months or longer. Furthermore, if a payer removes a provider from a panel for an expired medical license and a recredentialing request is not submitted in time, the appeal process can take 1-2 months – more revenue lost on mismanaged provider data.