Payer Enrollment for Behavioral Health
The demand for mental health services has never been greater, yet enrolling behavioral health providers poses unique challenges. Commercial insurance plans may have separate networks for behavioral health providers and requirements for Medicaid enrollment vary by state. Discover how to dismantle the roadblocks to successful payer enrollment for behavioral health providers.
Explain the elements of a typical behavioral health provider enrollment checklist
Identify 5 primary provider types and services
Describe the appeals process for denials
Payer Enrollment for Large Health Systems
Timely payer enrollment is the cornerstone of revenue management for large health systems, yet payer enrollment specialists can face challenges gathering complete packages of information from providers. Discover how to scale payer enrollment processes to achieve revenue management goals.
Describe 3 strategies to master varying state requirements
Explain the importance of managing timeline expectations
Identify processes to ensure provider CAQH entries are accurate
Payer Enrollment for Multi-Specialty Groups
Multi-speciality groups face unique payer enrollment perils, ranging from payments that are sent to a physician’s primary practice to inadvertently changing a new practitioner’s existing CAQH profile. Learn how to build effective relationships with stakeholders to manage a dynamic environment. Then, discover how to create robust internal processes to identify payer enrollment issues.
Explain the impact of primary and secondary taxonomy codes on payment
Identify solutions that allow groups to operate effectively in multiple geographic locations
Describe how to best utilize national and state credentialing portals used by payers to maintain current information
Equipped for Success
Payer Enrollment for DME Providers
Payer enrollment processes for DME providers are substantially different than for practitioners. Discover payer challenges and solutions for DME providers, including enrollment requirements, processing times, and technology options. In addition, they’ll cover closed or narrow payer panels, required screenings, and licensing requirements.
Identify 5 common challenges when enrolling DME providers
Explain the steps involved in screening DME providers
Describe the licensing requirements for each type of DME provider
Payer Enrollment for Delegated Providers
Payer enrollment for delegated providers provides opportunities to create efficiencies within the payer enrollment process, as well as in other essential business functions. Learn how to enter into delegated agreements with payers, navigate payer reviews, and streamline submission, tracking, and reconciliation.
Explain the advantages of combining delegated providers on a single roster
Identify 3 methods of streamlining tracking and reconciliation
Describe how to ensure provider data accuracy and directory compliance
Setting Up NPPES & CAQH
NPPES and CAQH are the building blocks of successful payer enrollment, and nine out of ten private insurers use CAQH for certain provider types. Discover challenges and best practices for setting up NPPES and CAQH. Then, discover streamlined processes for keeping provider information up to date.
Explain the application process for an NPI
Identify 3 processes that expedite CAQH configuration and set-up
Describe when and how to set up surrogacy to perform application functions