Payer Enrollment

TriumpHealth delivers comprehensive solutions for payer enrollment across all specialty types, encompassing government, private, and commercial payers
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PROVIDER CREDENTIALING & PAYER ENROLLMENT

Improve Compliance and Increase Revenue With Our Payer Enrollment Services

The payer enrollment process allows providers and practices to be enrolled for the services they provide and verifies that the payers have the information they need to process claims that are filed. Becoming an in-network provider allows you to get paid for your services accurately and promptly. The provider enrollment process is also critical for ensuring that healthcare providers are properly credentialed and qualified to provide care to patients. It also ensures that providers are in compliance with regulations and standards set forth by the payer or government program.

TriumpHealth’s credentialing specialists monitor the enrollment process each step of the way to ensure that you are enrolled as fast as possible. We keep you informed of any progress on you and your practice’s enrollment.

Streamline Your Payments With Our Payer Enrollment Services Today!

Our team not only focuses on getting your payer enrollment services, but we also ensure that your information is safe and secure throughout your enrollment process. We utilize a HIPAA-compliant portal for the easy and safe transfer of information between our clients and our credentialing specialists. We are dedicated to helping you focus on the job that you do best, with a team that you can trust.

Steps of the Credentialing Process

Information Collection

State licensing boards are responsible for issuing licenses to healthcare professionals and maintaining their records. They are an essential source of information for primary source verification, as they can confirm a professionals education, training, and licensing history.

Information Review

The TriumpHealth credentialing team checks for the completeness and accuracy of all information the client uploads. If any information is missing or outdated, we will notify the provider of what additional documentation is needed to complete their applications for each payer.

Letter of Interest Submission

Our credentialing specialists create a letter of interest (LOI) for each payer and submit them on each provider’s/practice’s behalf.

Application Creation

Our credentialing specialists complete each payer application with all necessary information provided by the client.

Application Submission

The applications are submitted to the payers, and an answer regarding if the markets are open or closed should be received in 30-45 days.

Follow Up

Our provider enrollment and credentialing services follow up on each application regularly and provide monthly updates to the client. The persistent follow-up process that we have implemented allows us to hold payers accountable for the work that needs to be done on the applications.

Acceptance or Denial

A final decision regarding a provider being accepted into the network is made by the payer enrollment, and the internal filing process for the payer begins. Once the internal filing is complete, the provider will be able to bill out according to the contracts obtained. In the case of a denial, our credentialing specialists can appeal to a payer up to 3 times for a client.

Frequently Asked Questions

What is payer enrollment, and why is it a critical step for healthcare providers participating in insurance networks?

Payer enrollment is the process by which healthcare providers become contracted with individual insurance payers to receive reimbursement for services rendered to patients covered by those plans. It is a critical step for providers participating in insurance networks as it allows them to bill for services, receive reimbursement, and ensure continued access to patients with insurance coverage.

How do you initiate and manage the payer enrollment process for healthcare providers, ensuring compliance with individual payer requirements and regulations?

We initiate and manage the payer enrollment process by gathering necessary documentation, completing enrollment forms, and submitting applications to each payer on behalf of the provider. Our team ensures compliance with individual payer requirements and regulations by closely following payer guidelines, communicating with payer representatives, and monitoring application progress.

Can you explain the typical timeline for payer enrollment, and what strategies are employed to expedite the process while maintaining accuracy?

The typical timeline for payer enrollment varies depending on factors such as payer responsiveness, application complexity, and provider readiness. To expedite the process while maintaining accuracy, we prioritize timely submission of applications, closely track application status, and communicate proactively with payers to address any issues or delays that may arise. The average time a provider can expect is 90-120 business days from the date of application submission.

What information and documentation are required from healthcare providers during the payer enrollment process, and how do you ensure the completeness and accuracy of these details for different payers?

Information and documentation required from healthcare providers during the payer enrollment process may include provider credentials, practice location information, tax identification numbers, and malpractice insurance coverage. We ensure the completeness and accuracy of these details by carefully reviewing application requirements for each payer, verifying documentation against payer specifications, and communicating with providers to address any discrepancies.

How do you stay updated on changes in payer requirements and policies, and how does this information impact your approach to payer enrollment services?

We stay updated on changes in payer requirements and policies through ongoing education, regular communication with payer representatives, and participation in industry forums. This information impacts our approach to payer enrollment services by enabling us to adapt quickly to regulatory changes, anticipate payer updates, and provide informed guidance to healthcare providers throughout the enrollment process.

Our Process

1

Application Submission

The medical practice initiates the credentialing process by submitting credentialing applications to insurance companies and healthcare organizations where the providers intend to practice. These applications typically include provider information, education, training, licensure, certification, and practice history.

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2

Verification and Review

The credentialing entity verifies the accuracy and completeness of the information provided in the credentialing applications. This process involves verifying provider credentials, such as licenses, certifications, education, training, work history, malpractice history, and professional references. Credentialing organizations may also conduct primary source verification to ensure the authenticity of credentials.

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3

Committee Review and Decision

Credentialing committees or credentialing boards review the verified information and make credentialing decisions based on established criteria and standards. This review process may include evaluating the provider’s qualifications, competence, ethical conduct, and adherence to professional standards. If the provider meets the credentialing requirements, the credentialing committee approves the provider’s credentialing application.

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3

Contracting and Enrollment

After successful credentialing, the medical practice enters into contracts or participation agreements with the insurance companies or healthcare organizations. These contracts define the terms of participation, reimbursement rates, and contractual obligations. Once contracts are finalized, providers are enrolled in the insurance plans or networks, allowing them to bill for services rendered to patients covered by those plans.

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Benefits of Working with TriumpHealth

Payer Enrollment

Streamlined Enrollment Process

We simplify your path to participating with payers, ensuring a timely and accurate submission of applications.

Compliance & Accuracy

Our team stays current with the latest guidelines to maintain compliance and prevent delays due to errors or incomplete information.

Customized for Healthcare Providers

Whether you are a solo practitioner or a large healthcare organization, our services are designed to meet your unique needs.

Strong Network Relationships

We leverage our existing relationships with payers to facilitate better communication and quicker turnarounds.

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We will help you achieve financial and regulatory compliance goals resulting in improved patient outcomes and increased revenue.