Payer Enrollment Prime

Description

Joining Forces
Merging Credentialing and Payer Enrollment
Increasingly, healthcare organizations are combining payer enrollment and credentialing. This integration is occurring in environments ranging from hospital systems to managed care, often as a result of organizational mergers and acquisitions or departmental consolidations. Join Team Med Global’s payer enrollment team as they outline the functions of this new frontier, which include credentialing, billing, and contracting. Then, take a deep dive into TMG’s payer enrollment model, which provides you with a step-by-step guide to enrolling practitioners in federal, state, and commercial plans.

Objectives:

• Identify five parallels in payer enrollment and credentialing processes
• Describe three opportunities for collaboration between payer enrollment and credentialing teams
• Explain the 8 steps of the pre-enrollment process and the four steps of the post-enrollment process

Keeping Revenue Streams Flowing
Why Payer Enrollment Matters
Seamless payer enrollment is critical to the viability of your organization because reimbursements hang in the balance. Join Team Med Global’s payer enrollment team as they explain how successful payer enrollment supports your organization’s overarching goals.

Objectives:

• Describe the links between payer enrollment, provider payments, and an organization’s fiscal health
• Identify opportunities to increase the effectiveness of your organization’s payer enrollment process
• Learn best practices that will help meet your organization’s KPIs for payer enrollment

Solving the Puzzle
Payer Enrollment Pointers
Payer enrollment can be a jumble of processes, exceptions, and stakeholder challenges. Join Team Med Global’s payer enrollment team as they discuss pain points and solutions to streamlining processes that enable you to fill in the puzzle pieces and achieve the big picture of revenue generation.

Objectives:

• Understand the pain points of each stakeholder in the payer enrollment process
• Explain a framework for implementing solutions that streamline payer enrollment
• Identify automation features that can enhance your payer enrollment process

APP-Avalanche
Payer Enrollment for Non-Physician Practitioners

Payer enrollment specialists are adept at juggling and tracking multiple providers. However, advanced practice professionals – such as nurse practitioners, physician assistants, and registered nurse anesthetists – can pose an avalanche of challenges to an industry once geared to physicians. Team Med Global’s Donna Goestenkors, CPMSM®, EMSP, and Yesenia Servin, CPMSM®, PESC, discuss mechanisms to streamline payer enrollment for non-physician practitioners and achieve optimal revenue recovery.

Objectives:

• Pinpoint credentialing and payer enrollment differences between physicians and APPs
• Describe strategies to streamline APP applications for commercial health plans
• Identify solutions to common enrollment challenges for APPs

Apples, Oranges, and Bananas
Defining Payer Enrollment Competency

Many of us consider ourselves to be payer enrollment specialists, but what does payer enrollment competency really mean? Team Med Global’s Donna Goestenkors, CPMSM®, EMSP, and Yesenia Servin, CPMSM®, PESC, provide an overview of Executive Payer Enrollment Competency Model and outline Team Med Global’s Executive Payer Enrollment Professional education program.

Objectives:

• List 12 distinct payer enrollment functions
• Explain common challenges presented by a lack of training standardization
• Name 3 competency areas for payer enrollment professionals

Tech-Tastic!
Streamlining CAQH Applications
The Council for Affordable Quality Healthcare database is the cornerstone of payer enrollment, with nine out of ten private insurers using CAQH for certain provider types. Yet, incomplete CAQH applications delay enrollment and have an immediate impact on an organization’s bottom line. Team Med Global’s Donna Goestenkors, CPMSM®, EMSP, and Larry DeHoyos, CPCS®, PESC, reveal processes designed to increase CAQH efficiencies and utilization, and to fast-track reimbursements.

Objectives:

• Identify three processes that expedite CAQH configuration and set-up
• Describe best practices for communicating with providers
• Contrast the strategies for the CAQH Practice Manager module and the CAQH Provider module