Provider Contracting

Understanding Your Provider Contract Fully

Devonn Simmons
September 15, 2021
11:00 am

Provider Enrollment (Initial and Re-credentialing) – this is the process of enrolling a group or a provider with the insurance payers, also called payer enrollment or credentialing. It can often be a lengthy process depending on the payer and can sometimes take about 4 -6 months to complete. Providers typically do not have the time to follow up or respond to requests from the payers. Often the payers end up closing the application because the providers did not respond to their requests promptly. So we, as a Provider Enrollment and Credentialing Company, take that burden off of them. We submit the applications and follow up with the payers every two weeks to make sure everything is still in process and that they are not waiting on any documentation that could slow the process down. We provide our clients with a weekly summary every Friday, so they always know where they are in the process.

Why you need to Understand your Provider Contract Fully:

To receive reimbursement for medical services, providers depend on provider contracts in healthcare. The Contract features all of the information that needs to be collected by physicians from their patients before sending a claim for reimbursement to the payer. Reimbursement or refund can be delayed or even denied if the claim procedures don’t strictly follow the guidelines set up in the provider contract. To ensure correct claim procedures and a steady revenue flow, here are a few essential details that are outlined in any Provider contract:

Rates for billed medical services
The time frame within which the health care provider must submit a claim for reimbursement
The time frame within which the payer must reimburse the provider once a claim is received
Scope and type of health care services that the payer covers
The procedure by which the provider can dispute a claim denial
How many days either party must notify the other before terminating the Contract

Mistakes or missteps in these processes can be a massive setback in setting up your Contract and may gravely cost your practice time and money. Since you’re in the healthcare business, you know that you need to overcome several challenges. The amount of time it takes to conduct the Provider Enrollment and Contracting can be a lengthy and time-consuming process. Provider Enrollment and Contracting with the payers are becoming more demanding and strenuous every single day. With most insurance panels getting a bulk load of work due to the burst in membership applications and a lot of them being particular about enrolling providers, the process of enrolling or registering your facility is becoming more challenging. Under the circumstances, outsourcing your credentialing and enrollment not only looks like an attractive option to increase efficiency but also makes financial sense. Nowadays, it is a challenge to be an expert in all aspects of your industry. This is why many healthcare professionals consider outsourcing their Contracting and Provider Enrollment process to ensure quality outcomes. Companies offering Medical Contracting Services such as Contracting Providers are trained to vet candidates, so why not leave this part of the job up to an experienced counterpart who may yield more successful results? Especially if it keeps you from the hassle and ensures you the highest quality of service. Our company, Contracting Providers, has helped providers with enrollment and contracting for the past 40 years, so we pride ourselves on our vast experience. We go through paperwork and know how to avoid setbacks. We specialize in the language payor groups and insurance use, helping us glide through data and rarely make mistakes. Having dedicated personnel to watch the changing industry is a must. We pay close attention to requirement updates per state and notify you if something has changed. This is a full-time task that doesn’t allow room for error. Between using internal resources, time, and labor, expenses associated with keeping some services in-house add up. We help ongoing expenditures stay low and reduce tasks that clutter you or your staff’s to-do list. We are constantly communicating with payor group representatives, and we have developed exclusive access to many of them. We ignore automated systems and middlemen because we have the direct line to who we need. We operate in a limited capacity – focusing on specific healthcare industry tasks – making us fast and efficient at what we do.