The National Provider Enrollment Virtual Event is a one-of-a-kind online event focused on education for provider enrollment professionals, enrollment managers, and credentialing specialists.
Given the high stakes and complexity of provider enrollment, aligning the function with traditional medical staff services work requires a clear strategy, strong approaches, and adept staff. Otherwise, the process may unravel, jeopardizing revenue, care access, and practitioner satisfaction.
Practitioners undergo different levels of education and training, including medical or professional school, and internship, residency, and fellowship programs. The health plan is only required to verify the highest level that the applicant completed. For a physician, this would usually be the...
The provider enrollment process helps ensure that organizations are reimbursed for the care their practitioners provide patients. While it’s easy to focus on the main streams of revenue, provider enrollment professionals must be careful not to overlook the smaller streams that can easily escape...
Once a managed care application is successfully submitted and verified, a final review should occur to confirm that the file meets the plan’s requirements before it is presented for final consideration by the credentialing committee or, if authorized, the medical director. This can be...