Slide 1

Starting Up Your Enrollment Operation February 11, 2015 Donna Goestenkors, CPMSM and Dina Solis 1 Slide 2 Session 2: Starting Your Enrollment Operation 2 Slide 3 Donna Goestenkors, CPMSM +Team Med Global Consulting, LLC 3 Slide 4 Dina Solis, Owner +Sonoma Credentialing Services 4 Slide 5 OBJECTIVES Walk through Payor Enrollment application elements and process. Learn Enrollment success tips. 5 Slide 6 PREPARE YOURSELF You cant make positive discoveries that make your life better if you never try anything new. ~Josh Kaufman, Author & Business Advisor 6 Slide 7 Payor Enrollment Enrollment is the process of applying to health insurance plans/networks for inclusion into provider panels to bill and be paid for services rendered. 7 Slide 8 TYPES Federal & State Private & Commercial Workers Compensation 8 Slide 9 Two Steps Pre-Enrollment Post-Enrollment 9 Slide 10 What is the Process? Pre-Enrollment +Step 1 Determine Which Plans to Enroll. +Step 2 - Collect Provider Info & Documents. +Step 3 - Obtain, Complete & Submit Application. +Step 4 Follow up Until Determination is Made. 10 Slide 11 Pre-Enrollment Step 1 Determine Which Plans to Enroll +Pre-determined based on group/hospital etc.? +If not, resources (AIS Directory of US Health Plans). +Go to payors website, call Provider Enrollment for enrollment timeframe, any special requirements or forms, and preferred submission method/address. 11 Slide 12 Pre-Enrollment Step 2 Collect Provider Info & Documents +Pre-application, CAQH, NPI registry, repository. +Review/QA for completeness/accuracy. +Check addresses, zip codes and counties on USPS website. +Check names/addresses/expiration dates on licensure and supporting documents. 12 Slide 13 Pre-Enrollment Step 3 - Obtain, Complete & Submit Application Application Elements +Instructions (great reference for most questions!) +Provider Identifying Information, Education, Training +Provider Licensure, Certifications, Affiliations +Provider References & Work History +Practice Information/Description/Services +Professional Liability Insurance 13 Slide 14 Pre-Enrollment Step 3 - Obtain, Complete & Submit Application Application Elements (Continued) +Billing Info/Clearinghouse/3 rd Party Administrator +Attestation Questions/Disclosures +Ownership/Controlled Interest Disclosure +Information Release/Acknowledgements +Provider Agreement(s)/ EFT Agreement +Checklist of Attachments 14 Slide 15 Typical Application Attachments Required +All applicable Professional, Medical, Federal, State, & Local Licensure, Certifications, Registrations. +IRS Issued CP575 & Signed/Dated IRS W9. +Articles of Incorporation/Partnership Agreement, etc. +Professional Degree, Fellowship, Residency, CEU, DL/Pic. +Professional & General Liability; Workers Comp (if app). +Copy of Voided Check (for EFT agreement). +Copy of Lease Agreement for Practice Location (CA). +Application Fee (if applicable). +Cover Letter (paper applications only). 15 Slide 16 Pre-Enrollment Step 4 Follow up Until Determination is Made Communication, Communication! +Follow up with payor (email, phone, fax). +Respond promptly to any requests for more info. +Give updates to provider or supervisor/log into system. +If approved, you may need to ask for an acceptance/welcome letter, or duplicate letter. +If denied, ask why and when to re-apply. 16 Slide 17 What is the Process? Post-Enrollment +Step 1 Obtain Proof of Enrollment/Denial. +Step 2 Implement with Billing Department. +Step 3 Record/Load New Contract in Database. +Step 4 Maintenance for Continued Enrollment. 17 Slide 18 Post-Enrollment Step 1 Obtain Proof of Enrollment/Denial. Step 2 Implement with Billing Department +Assist with any applicable EFT, EDI, ERA paperwork. Step 3 Record/Load New Contract in Database +Executed copies; welcome letter; ensure provider is loaded into payer network system. Step 4 Maintenance for Continued Enrollment +Send any changes/updates/lics. to payer; re-attest. 18 Slide 19 Success Points +Begin the enrollment process immediately upon colleting providers information/documentation. +Automate the enrollment process to the greatest extent possible with credentialing software. +Lessens errors & omissions. +Minimize the use of paper forms whenever possible. +Expedites process with some payers. + Respond to payor requests as soon as possible. + Communicate proactively with providers! 19 Slide 20 POWER THOUGHT Your resources are always far greater than you imagine them to be. Never ask, Can I do this? Ask instead, How can I do this? ~Dan Zadra - Author 20 Slide 21 And now, a word from our sponsor Provider Credentialing From symplr (formerly Medkinetics) For the person who wants to DIY the enrollment process Provider Credentialing provides: Dynamic Payor Enrollment forms Enrollment status tracking logs Enrollment reports For more information email sales@symplr.com 21 Slide 22 Q&A Ask your questions in the chat box and well get right to you If we dont get to your question during this session, someone will follow-up with you after the session! 22 Slide 23 Save the Date: Enrollment Series Session 3:Running a Successful Payor Enrollment Operation Wednesday, March 11, 2015 Noon 1:00 p.m. CST 23 Slide 24 Speaker Contact Information Donna Goestenkors, CPMSM +Team Med Global Consulting, LLC +Donna@teammedglobal.com +Telephone: (618) 830-0057 +Website: www.teammedglobal.comwww.teammedglobal.com +Like Me: www.facebook.com/teammedglobalwww.facebook.com/teammedglobal +Connect with Me: www.linkedin.com/donnagoestenkorswww.linkedin.com/donnagoestenkors +Follow Me: www.twitter.com/teammedglobalwww.twitter.com/teammedglobal 24 Slide 25 Speaker Contact Information Dina Solis, Owner +Sonoma Credentialing Services +P.O. Box 4661 +Petaluma, CA 94955-4661 +Dina@sonomacredentialingservices.com +Telephone: (855) 707-9995 +Website: www.sonomacredentialingservices.comwww.sonomacredentialingservices.com +Like Me: www.facebook.com/SonomaCredentialingServiceswww.facebook.com/SonomaCredentialingServices +Connect with Me: www.linkedin.com/in/dinasoliswww.linkedin.com/in/dinasolis 25 Slide 26 Credentialing Tool 26 Slide 27 The Medical Services Professional Career Guidebook Features include: +Frequently asked career questions by MSPs +Sample job descriptions, career assessment tools, competency development plans and more +Real-life stories to illustrate career decisions +Purchase today or order your copy: www.teammedglobal.com donna@teammedglobal.com gday@kamama.net 27 Slide 28 28 Slide 29 Team Med Global Newsletters & Blogs 29 Slide 30 Thank You! 30