Primoris Credentialing Network is the largest credentialing IPA in the Midwest and one of the largest in the United States. What does this mean? What is a credentialing IPA? How can Primoris help healthcare providers enroll in health plans and networks? How can this save time and money? The answers to these questions can paint Primoris as the provider enrollment solution you can turn to when providers need to begin billing as quickly as possible.
What is a Credentialing IPA?
Speed and accuracy are crucial elements of successful provider enrollment. A credentialing IPA like Primoris Credentialing Network can expedite the process so providers can get to work and begin billing faster. IPAs (Independent Physician Associations) are groups of independent medical providers who are committed to promoting quality healthcare services. IPAs strive to offer an efficient and effective healthcare delivery system that includes maintaining the bonds between providers and their patients.
Primoris Credentialing Network can help physicians within their IPA focused on delivering the most comprehensive health care to their patients without having to worry about the hassles of provider enrollment, including the elaborate application process and the credentialing process’ financial costs.
What is Provider Enrollment?
Provider enrollment, or payor enrollment, is the process in which providers apply for and contract with health plans and networks as well as Medicare and Medicaid. When providers perform every enrollment procedure, they can receive payment for their medical services. Provider enrollment is a highly-involved, detail-oriented series of steps that healthcare providers must complete. One of the major steps is the traditional credentialing process, in which 52+ conventional credentialing actions can require the constant exchange of information.
Providers who collaborate with an expert in this field can easily navigate the complexities of varied applications that are different based on state, specialty, health plan, and/or network. A provider enrollment expert can keep providers on the right track, helping them maintain the efficiency of their health services. While one expert can reduce the enrollment burden on providers, an entire team like the one at Primoris can all but guarantee that providers are enrolled in health plans faster than ever, especially when faced with convoluted policies.
Credentialing regulations can vary from state to state. For example, the State of Oklahoma’s OHCA Policies and Rules is 50 chapters long. Buried within that policy’s terms is how to become and remain credentialed as a provider. Similar rules differ by state, plans, and network, illustrating how complicated the enrollment process can be.
The 3 Stages of Provider Enrollment
The Primoris team possesses the relationships, training, and experience to maintain compliance while being efficient and quick in the enrollment process. With access to 54+ health plan and network options across the Midwest, Primoris can conduct provider enrollment from credentialing to contracting.
Provider Enrollment Stage One: Credentialing
Credentialing is necessary for every healthcare provider who wants to be enrolled in any health plan or network option. Insurance companies do not want negligent medical professionals on their plans. Accepting them could eventually cost them money in claims and litigation. Credentialing can eliminate providers who are considered unfit to treat patients, potentially decreasing patient injuries and deaths as well as costly claims and lawsuits. Conventional credentialing, like everything else associated with provider enrollment, is complex.
52 actions must be performed before a file is ready for presentation, including:
- Sending, tracking, and receiving the provider application packet.
- Obtaining the provider’s release.
- Getting the privilege forms.
- Reviewing the disclosure’s questions and answers.
- Evaluating the explanations of time gaps and claims history.
- Assessing medical malpractice claims history.
- Authenticating medical school internship, residency, fellowship, and affiliations.
- Researching primary and out-of-state licenses for disciplinary actions.
- Obtaining a copy of the provider’s current certificate of insurance.
- Confirming any Medicare and Medicaid sanctions and exclusions.
- Performing an extensive 10-year criminal background check.
- Running a National Practitioner Data Bank query.
Primoris collaborates with its sister company, 5ACVO, to trim credentialing from 52 conventional credentialing steps down to just six (6) simple steps. Better credentialing can result in prompt provider enrollment, allowing providers to see patients sooner and begin billing faster.
Provider Enrollment Step Two: Plan Application
Each health plan has its own application process. Like enrollment policies, applications vary based on state, health plan, network, and area of practice. Learning how to apply to specific ones can take time providers typically do not have. Primoris can help providers overcome the struggles of applying to plans by allowing them to apply to 25+ delegated health plans and networks via one application. Another 25+ non-delegated health plan and network options are also available, allowing a variety of providers to get enrolled as soon as possible.
Primoris is delegated by most major plans in Oklahoma and is adding dozens of plans in Illinois, Missouri, and Texas. Delegation is achieved by meeting stringent industry standards and passing annual audits. Delegation provides unequaled efficiency and control over the total process. Delegated contracts allow Primoris to use one application to add a provider to various health plans. This method can prove much faster than traditionally sending an application to each option.
Primoris’ delegated payer enrollment with ONE application includes the following payers:
Primoris’ Non-delegated enrollment with strong payer relationships includes the following payers:
- BlueCross BlueShield of Oklahoma
- Cigna
- CommunityCare
- Medicare
- Preferred Community Choice PPO
- U.S. Department of Veterans Affairs – Veterans Health Administration
- And others!
Primoris’ relationships with these companies let providers begin billing as soon as the provider enrollment process is finished. These arrangements can benefit providers no matter the contract type. Primoris can leverage its history with these health plans to make enrollment easier than ever. The Primoris team is currently looking towards new horizons to increase the number of delegated health plans and networks they can offer its providers.
Provider Enrollment Step Three: Contracting
If all goes well, the health plan will send a contract to the provider to be reviewed and signed. Once the provider approves the terms and signs the contract, the plan counter-signs the agreement. The plan will complete the loading process and set the date when the provider can start accepting covered patients and begin billing.
Why Should You Outsource Provider Enrollment?
Medical offices that perform provider enrollment themselves have a lot of work ahead of them. Outsourcing the entire process to Primoris Credentialing Network can help reduce the turnaround time so billing can begin sooner rather than later.
Outsourcing provider enrollment can reap many other benefits including:
- Less work,
- Fewer costs,
- Fewer errors and delays,
- Powerful resources and
- Peace of mind.
Outsourcing provider enrollment produces: Less Work
Primoris’ sister company 5ACVO can simplify the credentialing process, reducing the 52 action steps to 6. Primoris’ single application for delegated contracts further streamlines the effort that goes into enrolling providers. Additionally, Primoris gives its members a single point of contact for all correspondence. Office staff and providers do not have to track down multiple people to check on application statuses or resolve other issues. Medical office staff can be free to work on other projects and leave provider enrollment to the experts.
Outsourcing provider enrollment produces: Fewer Costs
A Harvard study found that outsourcing provider enrollment can save a provider $29,000 a year. These savings can make or break a practice during these uneasy economic times. Providers and practices can lose even more money if there are any mistakes made during the process. Delays mean providers cannot bill. A deeper dive into the cost savings finds outsourcing provider enrollment an effective option in battling ballooning budgets and dwindling income. One report suggests that healthcare administrative expenses account for 8% of the total healthcare costs in the United States. Reducing these expenses should be of the utmost priority for any medical practice that is feeling the financial weight in today’s troubling economy.
Partnering with a credentialing IPA like Primoris can increase budget revenues and streamline costs. Providers that can see patients sooner can start billing faster. This means the provider enrollment process should be completed in the shortest amount of time possible without delay. Primoris’ commitment to simplicity eliminates the process’ inefficiencies and decreases the time until providers can bill.
Outsourcing provider enrollment can also reduce or get rid of the costs of hiring employees to manage the process. Not having to pay salaries, payroll taxes, and benefits can improve a beleaguered budget.
Outsourcing provider enrollment produces: Fewer Errors and Delays
Provider enrollment is such a meticulous operation that just one mistake can stop the entire process. This delay can cost providers time and, more significantly, money. Hiring experts like the Primoris team can minimize the risk of errors and oversights. Primoris’ team has 385+ years of industry experience. They know what can go wrong during provider enrollment and can sidestep any obstacles.
Outsourcing provider enrollment produces: Powerful Resources
In addition to a single application for delegated plans, one point of contact, and a highly-effective team, Primoris offers a secure web portal that providers and office administrators can take advantage of to stay on top of the enrollment process.
Primoris’ web portal lets users manage and monitor the process. Providers who have more control, but less work to do, can confidently see where they stand on their way to becoming enrolled. They can access all of their information and applications that are entered into the system. They can also modify documents, including rosters and enrollment requests. They can track information related to health plan enrollment, including current statuses, reappointment filings, and expiring documents. They can do all of these things and more from one web portal.
Outsourcing provider enrollment produces: Peace of Mind
The ultimate benefit outsourcing provider enrollment presents is peace of mind. The process might seem like an involved yet simple procedure. However, each step requires industry expertise, exemplary organizational skills, and a meticulous eye for detail. Provider enrollment can take months to complete.
Outsourcing the job and its associated burdens can free staff from the stress of doing the job right. They can focus on tasks they are better suited to handle. Providers can start billing. Everyone can work better in a stress-free environment, going beyond when treating patients. Peace of mind can be just as valuable as the revenue providers bring in.
The Primoris Commitment to Better Enrollment
Primoris Credentialing Network can offer a better credentialing and provider enrollment solution. With 54+ health plans and networks for provider enrollment options at its disposal, Primoris can create a simpler provider enrollment experience like never before.
“We believe in keeping it as simple as possible,” says Brad Bond, COO and Co-Founder. “Less paperwork is better. A single application for numerous delegated plans reduces paperwork, saving time and money.”
However, Primoris is not content with maintaining the status quo. As one of the largest credentialing IPAs in the country, Primoris continually strives to increase its reach by seeking partnerships with other health plans and networks. For example, in January 2022, Friday Health Plans contracted through Primoris. The Colorado health insurance company has already brought its consumer-focused health insurance model to New Mexico, Nevada, and Texas. Most recently, Primoris expanded into the Missouri and Illinois markets and continues to add payers every year.
A Credentialing IPA is Your Provider Enrollment Solution
Provider enrollment can sometimes be a demanding process that overwhelms healthcare providers and administrators. It is also essential to the revenue stream. Without it, providers and practices could find it impossible to earn income.
Primoris Credentialing Network wants to make the process better for everyone. As a credentialing IPA, it can pare down the process to accomplish its goal. Uniting experienced talent with modern technology can further their mission so qualified providers can do what they were meant to do.
More information about Primoris Credentialing Network
Primoris Credentialing Network is a NCQA Credentialing Accredited specializing in credentialing and provider enrollment with 54+ health plan and network provider enrollment options. Primoris is a family member of Fifth Avenue Healthcare Services. Sister companies include 5ACVO (credentialing and primary source verification specialists) and Fifth Avenue Agency (MPLI and medical malpractice specialists).
This article originally published by Primoris Credentialing Network here. For more information on Primoris Credentialing Network, please visit PrimorisCredentialingNetwork.com or Contact Us.
