As hospitals seek to maximize revenue, it is crucial they conduct a participating and nonparticipating analysis to ensure their provider enrollment data corresponds to the enrollment data that the payers have recorded, according to Patrick Doyle, senior vice president of Lynbrook, N.Y.-based Newport Credentialing Solutions.
Mr. Doyle shared the following tip with Becker's Hospital Review: "If a provider is not properly enrolled, they will not get paid. A participating and nonparticipating analysis is the process of validating the participating status of each provider across all plans, locations and tax IDs. This analysis is critically important in that it creates a baseline of who your providers are enrolled accurately with — and who they are not. By establishing an enrollment baseline and identifying which providers are not enrolled with your plans, you can take proactive steps to enroll them correctly to avoid lost revenue."
Read more about provider enrollment here.