Common credentialing mistakes that can decrease your revenue

Enrollment with insurance payers is a complicated and time-consuming process. Healthcare providers have to submit tons of paperwork and regularly follow up with insurance representatives to secure their participation with a certain payer or a benefit plan. Moreover, if done incorrectly, insurance credentialing can cost healthcare practitioners valuable time and money. If you have ever made a mistake while submitting an enrollment application, you probably know what it is like to experience a delay in reimbursement and a decrease in patient flow.

Today, we would like to shed a light on the most widespread miscalculations that our clients have encountered when doing credentialing on their own.

Mistake number 1: Incomplete application submission

Human beings tend to make mistakes. Sometimes we may forget to attach an important document to an enrollment application, while later we forget to fill in some information into a field that is marked as “required”. Nevertheless, payer credentialing does not tolerate such seemingly small errors. Submitting an application with any information missing in a batch of documents leads to delays in its processing, or even to rejections. Should an insurance credentialing representative notice a gap in your documentation, an application process would highly likely have to be restarted. With that in mind, a small typo can “postpone” your participation with a desired insurance plan for up to another 180 days.

Mistake number 2: Having outdated provider license and malpractice information

Healthcare providers must keep their licenses and certificates up to date in the states where they practice. If they let any of their credentials lapse, they risk practicing medicine without a license, perhaps exposing their companies to legal action. On a regular basis, every medical practice is responsible for ensuring that licenses are current and in good standing. State and federal databases update their exclusion lists on a regular basis, and this information can be accessed by commercial insurances. As a result, your enrollment will be rejected should you fail to keep your license in a good order.

Mistake number 3: Inconsistencies in primary source verification data

If an enrollment candidate fails to give exact or complete contact information for the institutions that awarded certain credentials (for example, a provider’s license), an application will be rejected by the payer. Insurance payers do contact such institutions, and a failure to validate a potentially participating provider’s information will halt the application process.

Mistake number 4: Failure to verify provider’s demographic information on a regular basis

Credentialing errors may occur even after enrollment has been processed. Namely, healthcare practitioners who fail to keep their record in good order with insurance payers, risk losing their enrollment. It is highly recommended to regularly catch up with insurance payers that you are active with to ensure that your practice demographics are set up appropriately. Changes in practice location, tax ID, and other important pieces of information cannot go unnoticed by insurance payers, as by healthcare providers.

A quick reminder: We Can Help you keep your enrollments in good order. Our unique annual Credentialing Reassurance service keeps exclusions and deactivations at bay for just $1200 per year. Check it out:  https://wchsb.com/provider-credentialing/

Mistake number 5: Putting too much pressure on an inexperienced staff

Insurance credentialing is an extremely cumbersome process. Hence, it should only be done by someone who possesses an extensive knowledge in contracting. Based on past examples of our clients, we do not recommend you delegate this process to your front desk or any other individual whose main responsibility is not related to provider credentialing.

In 2022, the best solution is to outsource your enrollment to WCH Service Bureau. Our credentialing experts have over 2 decades of experience in making providers enrolled with hundreds of insurance plans.