Align credentialing and enrollment processes

In many organizations, the board’s decision to approve or deny privileges marks the end of the new provider credentialing process for the MSP. However, this endpoint is changing as many hospitals integrate their medical staff services and provider enrollment functions into one department, says Amy Niehaus, CPMSM, CPCS, MBA, president of AMN Consulting. With integrated departments, onboarding of employed practitioners includes credentialing and privileging, but now ends after successfully enrolling practitioners with commercial insurers, Medicare, and Medicaid, Niehaus says.

Waiting to start the enrollment paperwork until a provider is approved by the board extends the onboarding process unnecessarily. “It really adds up when you’re talking about daily revenue opportunities that a physician can bring in,” says Niehaus. Integrating also makes it easier for credentialing and enrollment to happen concurrently, says Joanna Hazell, senior manager of provider services at Brigham and Women’s Hospital (BWH) in Boston. BWH is a centralized office where 17 MSPs credential 5,000 providers, including staff physicians, residents, and AHPs, and eight enrollment specialists enroll 2,580 of those providers with their contracted health plans.    

“While the credentialing process is taking place, the enrollment team can begin prepopulating all the different enrollment applications and contracts that the physicians need to sign,” Hazell says. Working hand-in-hand with MSPs also lets enrollment specialists determine the best time to send the enrollment applications to health plans.

“We have to get confirmation that credentialing is complete, and it will be approved at the next committee. Then we submit [the applications] to the health plans,” Hazell says.

Source: News & Analysis