Understanding Credentialing and Enrollment Processes: Healthcare Organizations vs. Health Plans

As someone who manages or oversees provider credentialing and payer enrollment for your hospital or healthcare organization, you understand the value of maintaining efficient processes across departments to save time, reduce costs and ensure providers are granted privileges as quickly as possible. Health plans (also known as managed care organizations) strive for similar goals. Understanding the payers’ specific accreditation and regulatory requirements can help you and your team of medical services professionals further ensure timely processing of provider applications.

This six-page white paper, Understanding Credentialing and Enrollment Processes: Healthcare Organizations vs. Health Plans, by Amy Niehaus, CPMSM, CPCS, MBA will explore:

  • The processes payers conduct to evaluate and enroll healthcare providers
  • Common challenges in provider enrollment and how to solve them
  • Tips and techniques to achieve delegated credentialing

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