Do you struggle with credentialing your newly recruited providers? Does your staff have the time and expertise to navigate the time-consuming and complicated process of enrolling your doctors and allied professionals into Medicare and other health insurance plans? If not, you are not alone. Many practices are overburdened with the complex and ever-changing enrollment guidelines set forth by Medicare and the insurance companies. Delays in credentialing result in lost revenue and, ultimately, diminished growth potential of your practice.
PivotHealth offers three core Provider Enrollment services:
- Application Processing
Application processing consists of commercial payor enrollment, government payor enrollment (Medicare & Medicaid), CAQH initial set up & maintenance, national provider identifier (NPI), enrollment process tracking (via Cactus Software) and bi-weekly reporting with detailed documentation. We gather your data and complete all payor applications. We submit your applications to the health insurance companies, and follow up on a regular basis to ensure applications are being processed efficiently. We maintain regular communication with you via telephone, e-mail, and detailed reports.
Contact us now for the Provider Enrollment Checklist. This list provides the information and forms we will need to start the provider enrollment process.
- Consulting
Consulting engagements can be on or off site and include staff education & training, departmental policies and procedures, best practices and Medicare enrollment workshops (Part B)
- Provider Enrollment Assessments
Assessments are conducted on site and include but are not limited to review of: claims denials, specific payor issues, current provider enrollment process and evaluation of staff. Process strengths and weaknesses will be identified, and an action plan provided for areas of improvement.
The PivotHealth Difference
PivotHealth was engaged to assess the Provider Enrollment department of a 150+ multi-specialty group of physicians in New York City. The assessment revealed that due to a lack of training and education, the Provider Enrollment department had failed to routinely enroll their providers into the Medicare program with only 51 providers being enrolled. As a direct result of this failure, during the previous 12 month period, 2000+ claims had been denied for non-participation. Intensive, on-site training was provided to the Provider Enrollment staff. As of July 2010, all but 5 members of the group have been successfully enrolled into the Medicare program. The group is pleased with the progress, their Medicare collection rate as well as their ability to attract an increasing number of Medicare patients.
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 The PivotHealth team has been a pleasure to work with on completing enrollment with all requested payors in a timely manner. Due to their experience and knowledge, the provider was enrolled within 30-60 days for the top five payors (Medicare, Medicaid, BCBS, Aetna and UHC). The practice is now immensely successful, and I highly recommend their services and look forward to working with them again in the future.
-Kay Syler
Office Manager
Southern Tennessee Cardiology, PLLC
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