Enrolling with an insurance payer is quite a complicated and time-consuming process. Healthcare providers normally have to wait for up to 4 months to become a participating provider with an insurance payer.
An insurance panel (or “a payer panel”, “an enrollment panel”) is a group of healthcare providers who cooperate (participate) with an insurance company to provide services to enrolled clients. Therefore, the process of entering an insurance panel implies getting credentialed with this insurance and becoming a participating provider. Each insurance company or benefit plan has its own enrollment payer. When a panel is “closed”, healthcare providers cannot submit an enrollment application to the insurance. On contrary, when it is “open”, practitioners and groups may proceed with credentialing themselves with the payer. Insurance panels are usually open during a strictly defined time period determined by the payer. Our experience shows that panels are closed when insurance has an excessive number of participating providers.
How to get into an insurance panel?
Although each insurance payer or a benefit plan has its unique enrollment requirements, the process generally has the following sequence:
I. Gather your documentation
Insurance companies have a strictly-determined list of documents that providers need to attach to their enrollment application. They normally include, but are not limited to:
· License information
· Demographics
· NPI and tax ID
· Taxonomy code
II. Contact your intended payer’s credentialing department
Once you have gathered all the documentation, it is crucial to find out all the possible ways of submitting an enrollment application. Then, you would need to know if a panel is currently open.
III. Submit your application
As soon as you have verified all the necessary information on a particular enrollment, please proceed with sending your documentation to the payer. You will then need to follow up with the insurance to make sure that your application does not get “lost”.
IV. Sign a contract
Yay! If your case is approved, all you need to do is to sign an enrollment contract with the payer. Please make sure to review and approve an effective date, and your individual provider fee schedule, if applicable.
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