One of the country’s only credentialing IPAs now offers 54+ health plan and network provider enrollment options. Primoris Credentialing Network includes services in Oklahoma, Illinois, Texas, and Missouri, becoming the Midwest’s largest credentialing independent practice association (IPA).
Serving doctors, surgeons, medical practices, and other medical groups, Primoris specializes in provider enrollment. A team of credentialing experts with 385+ years of industry experience enrolls providers into insurance plans, networks, Medicare, and Medicaid. The team ensures that each provider is efficiently enrolled as quickly as possible, allowing for reimbursement for their services. Combining great talent, cutting-edge technology, and a simple application process helps everyone enroll.
Credentialing Done Faster
Speed is one benefit clients come to enjoy when working with Primoris. The sooner a provider is enrolled, the faster they can see patients, which means swift billing. Primoris works with both delegated and non-delegated contracts. Delegated contracts result in faster provider health plan enrollment. Primoris has relationships with insurance companies such as Aetna, Humana, and UnitedHealthcare to offer delegated plan provider enrollment options.
The oft-quoted statistic is that it can take up to 60-120 days on average to complete provider enrollment. However, with Primoris, the average time to complete provider enrollment is much shorter.
For example, faster provider enrollment times with Primoris include:
- The average time to complete provider enrollment with BCBS is 27 days±.
- The average time of provider enrollment with Aetna is 33 days±.
- The average time of provider enrollment with United is only 9 days±.
Let’s look at a conservative example of provider enrollment with Primoris and the new revenue opportunities it creates. In the examples below, family practice revenues are referenced. However, revenue generated from a specialist and significant new revenue opportunities would be even higher due to a more efficient Primoris provider enrollment.
Here are three examples of generating new billing revenue through BCBS, Aetna, and UnitedHealthcare.
Example BCBS: new revenue opportunity of $78,540 with BCBS
- [(Industry low average enrollment time) – (Primoris enrollment time)] x (Average Daily Family Practice Revenue‡)
- (60 days – 27 days) x (ADFPR‡ of $2,380) = $78,540
- If BCBS is 10% of the practice payer mix, this equates to $7,854 in potential new revenue generation for EACH provider through Primoris with BCBS.
Example Aetna: new revenue opportunity of $64,260 with Aetna
- [(Industry low average enrollment time) – (Primoris enrollment time)] x (Average Daily Family Practice Revenue‡)
- (60 days – 33 days) x (ADFPR‡ of $2,380) = $64,260
- If Aetna is 5% of the practice payer mix, this equates to $3,213 in potential new revenue generation for EACH provider through Primoris with Aetna.
Example UnitedHealthcare: new revenue opportunity of $121,380 with UnitedHealthcare
- [(Industry low average enrollment time) – (Primoris enrollment time)] x (Average Daily Family Practice Revenue‡)
- (60 days – 9 days) x (ADFPR‡ of $2,380) = $121,380
- If Aetna is 5% of the practice payer mix, this equates to $6,069 in potential new revenue generation for EACH provider through Primoris with United.
In this example, looking at the above three carriers only, this equates to a new revenue opportunity of $17,136 for EACH provider enrolled through Primoris. The total revenue opportunity is much higher when considering the entire payer mix. Some healthcare practices perform the provider enrollment process themselves, wasting resources and amassing headache after headache. Relying on office staff and computer software that are ill-prepared to deal with the procedure effectively isn’t a smart business plan. Provider enrollment errors will halt the entire process. Practices these days can’t afford such costly time and money-consuming delays.
± This provider enrollment time is based on internal research of the number of days from getting the last needed applicant item until the effective date. Aetna’s effective date through Primoris is the first of the following month after approval, and UnitedHealthcare is the Primoris effective date.
‡The Average Daily Family Practice Revenue of $2,380 is from AAFP.org research stating family practice revenue averages $50,000 a month or $600,000 annually and dividing this by the number of actual working days in a leap year of 252 ($600,000/252 = $2,380). This is an estimate. A payor allocation of 10%, 5%, and 5% were assigned for BCBS, Aetna, and United. A higher total revenue opportunity could occur based on the actual payor mix.
Delegated and Non delegated Provider Enrollment
Primoris is just as effective in working with non-delegated health plans and networks. Their highly experienced team of specialists includes expertise with non-delegated provider enrollment options such as BCBS, Community Care, and Medicare.
Building relationships within these carriers over many years enables providers to begin seeing patients and billing as quickly as possible. Working with Primoris for delegated and non-delegated provider enrollment yields a bounty of benefits that cannot be ignored.
How Primoris Can Help
Outsourcing the provider enrollment process eliminates delayed payments to providers and has a higher probability of raising revenue, as discussed above. Employing a highly effective provider enrollment team can result in numerous benefits, including streamlined budgeting and cheaper access to experts.
Reducing expenses in these trying times is essential to the future of a medical practice that faces closure due to financial problems. 1,000+ providers trust Primoris to take care of all their provider enrollment needs. Primoris is a one-stop solution that offers smarter, simpler, and better enrollment.
More information about Primoris Credentialing Network
Primoris Credentialing Network is a NCQA Credentialing Accredited specializing in credentialing and provider enrollment with 54+ health plan and network provider enrollment options. Primoris is a family member of Fifth Avenue Healthcare Services. Sister companies include 5ACVO (credentialing and primary source verification specialists) and Fifth Avenue Agency (MPLI and medical malpractice specialists).
Primoris Credentialing Network originally published this article here. For more information on Primoris Credentialing Network, please visit PrimorisCredentialingNetwork.com or Contact Us.
