Question 1: Do you experience denials or low collections due to provider credentialing issues? - Management Resource Group, LLC Question 1: Do you experience denials or low collections due to provider credentialing issues? - Management Resource Group, LLC

Question 1: Do you experience denials or low collections due to provider credentialing issues?

Question 1: Do you experience denials or low collections due to provider credentialing issues?

Stop Gesture

If you are experiencing denials or low collections due to provider credentialing issues, you are not alone. Payor enrollment is a critical process for every medical provider but one that poses many challenges.

The Reason? Experience

Payor enrollment is not something medical providers do very often; and as a result, they make mistakes. Mistakes come in three forms:

  • Incorrect Information which accounts for 22% of the credentialing issues
  • Lack of Information accounts for 33% of the issues AND
  • Lack of Accuracy accounts for 45% of the issues

Outlined below are the Top 9 Payor Enrollment Mistakes and some hints on how to avoid them.

Mistakes are why medical providers experience denials and low collections when it comes to credentialling. Now, the simply reality is nearly every medical provider will eventually get through the Payor Enrollment process. It is just a matter of time, resources, and countless hours of frustration and rework.

This is why we recommend enlisting the help of revenue cycle management experts. Revenue cycle management experts are experienced and proficient when it comes to payor enrollment because it is what they do. Many RCM firms have dedicated teams that only focus on credentialling. They take the frustration and mistakes out of the process.

If you find yourself always trying to resolve credentialing issues, consider outsourcing your payor enrollment process.

Here are the Top 9 Payor Enrollment Mistakes and some advice on how to avoid them:

#9: Make sure you have the correct form for your provider type. Many forms have similar acronyms and numbers. If you don’t have the right form, your enrollment request will not be accepted, and you will have to start the process over again.

#8: Review your provider type form and make sure all the required fields are complete, and the Information is Accurate. Not every field on a provider type form is required. Knowing which ones to complete can be confusing. Failing to fully complete your provider type form can delay your acceptance into the network. If you are unsure about a field, take the time to check whether or not it is required.

#7: Check for clarity and spelling. The people reviewing your form will NOT give you the benefit of the doubt. Typos, hard-to-read copies, and poor penmanship can cause a delay in your acceptance into a plan and require you to resubmit your Payroll Enrollment forms.

#6: Verify your supporting current documents are current. This is an easy mistake to avoid and a very common mistake. Make sure the supporting documents are current and not expired. Submitting old documentation will result in unnecessary delays and aggravation.

#5: Always use full and complete legal names. When completing your provider form and when submitting supporting documents, make sure you consistently use the full legal name for your medical practice and the full and complete legal name for the authorizing agents and / or signatories. Always remember, your goal is to make it easy for the reviewer to verify and validate your information.

#4: Actively manage the process and provide prompt response. The Payroll Enrollment process is similar to applying for a mortgage loan or refinancing your home. There will be requests for more documentation or clarifying information. Make sure you respond quickly to those requests. If you fail to respond within their timeframe, your request will be denied. You may also risk supporting documents expiring during the review process.

#3: Make sure to sign the form and make sure the right person signs the form. This sounds silly, but it is one of the most common mistakes. You don’t want to go through all the work only to have your acceptance delayed because of a signature. Double check all signatures pages before submitting.

#2: Confirm realistic timeframes for processing. From contracts to credentialing, it is important to verify timeframes with payors and communicate the timeframes to your provider. Setting realistic and accurate expectations is important. Typical timeframes are from 90-120 days once a carrier receives the application.

#1: Avoid your CAQH account from lapsing / Ensure your CAQH is updated before the credentialing process. A change in status will significantly delay or cause your insurance request to be rejected. It is best to start the payor enrollment process after creating or updating your CAQH account.

If your practice is currently experiencing A/R management challenges having a negative impact on your bottom line, or if you would like to learn more about MRG’s outsourced revenue cycle management services, please speak with your CPA advisor or contact MRG’s Karrie Plaskett at 888-818-0563 ext 317 or or visit MRG’s website at

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