When to submit an enrollment application to payers

Along with their existing medical staff credentialing obligations, MSPs are increasingly tasked with managing provider enrollment duties. With a solid grasp of the payer credentialing process and requirements, MSPs can avoid payer credentialing delays to reduce lost revenue.

Q: At what point in the medical staff credentialing process can an application for enrollment be submitted to the payers?

Amy Niehaus, CPMSM, CPCS, MBA: Your payers may vary a bit here, but usually 60 days is a good benchmark as this should give them sufficient time to process. Payers don’t want them too early as information may go stale or because they need to focus on their current inventory of applications they already have in-house.

You should inquire as to what submission time frames your payers might be following, but it’s about getting the information to them as soon as possible so that they can start their process.

Again, payers are going to vary. The hardest thing to deal with in enrollment is that there’s not a lot of consistency among the payers with their processes and requirements. It’s always good just to go to that source and find out how early they can accept an application, knowing that it’s still going through your process. Then follow up and let them when the provider is approved and the final approval date.