Credentialing & Privileging | 10.07.20
Introducing the NAMSS Provider Enrollment Course
New this year, NAMSS is introducing the Provider Enrollment Course, a seven-part virtual series that provides a detailed overview of the scope of provider enrollment. Each part of this course is hosted by an industry expert who will cover all aspects of provider enrollment, from roles and responsibilities to standardizing processes.
NAMSS caught up with Provider Enrollment Course leaders Mathieu Gaulin (Boston Children's Hospital) and Chris Bergeron (symplr) to get an inside look at the course, including how they got involved, the course’s goal, and how it benefits the MSP of tomorrow. Read on to learn more about this exciting new opportunity for MSPs and provider enrollment professionals.
NAMSS: Share some background about the NAMSS Provider Enrollment Course. What can attendees expect from the seven-part workshop?
Mathieu Gaulin (MG) and Chris Bergeron (CB): Attendees can expect to get a better understanding of the basics of provider enrollment from multiple vantage points — for example, those working in an academic teaching hospital, a community hospital, a third-party CVO, or a payer organization.
In addition, we’ll cover roles and responsibilities so attendees can gain an understanding of the typical breakdown of work, including potential overlap so they can spot inefficiencies, among the various roles from start to finish in the enrollment process. We’ll share our collective years of knowledge to help attendees unravel the sometimes tricky terms used during the enrollment process. Attendees will walk away with a toolbox of tips and tricks to help them better navigate the provider enrollment process. Finally, here are some other topics we’ll touch on:
- Important standards and regulations, especially related to the government payers
- Critical skills to elevate the role of the provider enrollment professional (PEP) (and MSP)
- A better understanding of CAQH
- A perspective on provider enrollment from the payer point of view
- Pro tips!
NAMSS: What is the goal of the Provider Enrollment Course?
MG and CB: Our goal is to educate all credentialing professionals/MSPs about the opportunities for collaboration, efficiency, and cohesion between provider enrollment and credentialing. We also aim to elevate the role of the PEP and integrate them more into NAMSS’ infrastructure. Last but not least, we’re striving to educate existing PEPs — and those aspiring to be one — about the importance of their role from a group of committed MSPs/PEPs who have been in the enrollment trenches. Essentially, our goal is to bring PEPs more into the fold and into the discussion about this crucial profession.
NAMSS: Define provider enrollment. What is it, and what does it entail?
MG and CB: Provider enrollment (PE) is the process by which a provider is added to an insurance plan’s network to ensure timely patient access. It also is a crucial step in any healthcare organization’s ability to generate revenue. Providers’ applications to payers (insurance companies both commercial and government) are submitted according to NCQA, CMS, and/or plan regulations to enable them to be verified, credentialed, and/or screened to ensure that they meet all requirements.
NAMSS: What Provider Enrollment Course topics are most important to you personally?
MG: Although somewhat biased, since I’m one of the speakers, I’m most excited about the critical skills session with Jenny Jackson. The effective PEP succeeds in the background, but we want to make sure they thrive in the foreground, and that is our goal for the session — how to take the knowledge and skills learned from being a PEP to expand your reach to become a fully rounded MSP/PEP.
NAMSS: Like other NAMSS courses this year, the Provider Enrollment Course is offered in a virtual format. Why is it necessary for MSPs to take advantage of these virtual educational resources, especially during unconventional times?
MG: Although I am not a strong advocate for another Zoom, I do believe in continuous learning and continuous development, so I hope people take advantage of this opportunity. PE is not like credentialing, where the process and regulations are more standardized across the country. PE is very regionalized, so learning from colleagues is typically the best and most effective way to build your professional toolbox. PE can sometimes feel like a solo sport, but hopefully this series will show participants the opportunities for collaboration and increased knowledge.
NAMSS: Why is this course necessary for the MSP of tomorrow?
MG and CB: The MSP of tomorrow needs to have a well-appointed toolbox of professional and technical skills. Provider enrollment is the other side of the credentialing coin. As MSPs grow in importance and visibility, PE is a natural area for them to grow into. Even if they do not directly manage PE, knowing how their work impacts PE is invaluable to an organization. Furthermore, as we enter an uncertain economy, small changes to processes in credentialing and PE can have a huge impact to timely enrollment dates, which positively affects the bottom line. In brief: It’s about the $$$, y’all!
NAMSS: What skills are necessary for an MSP to master provider enrollment?
MG and CB: Other than the technical skills, we say:
- Be a liaison, and work collaboratively with multiple internal and external stakeholders to affect the enrollment process in a way that positively impacts the bottom line and gives patients timely access to care.
- Be an advocate and a champion for PE both internally and externally, so that the importance of the role is better understood across the healthcare spectrum.
- Be a networker, and share information among colleagues about best practices in your community, state, or region. This will help to elevate the PEP role and create affinity.
- Be a good manager of expectations by ensuring that everyone is on the same page about realistic provider start dates, but also to allow you some flexibility in the process, because it is rarely a straight line!
NAMSS: Share a bit about your experience with provider enrollment in your work.
MG: I started at Boston Children’s Hospital in 2006 working in provider enrollment and have since created a provider enrollment team with a manager and seven FTEs focused on enrolling and maintaining enrollment for about 1,900 billable providers, across 19 tax IDs and out-of-state Medicaid in up to 42 states. I am now the director of health affairs, directly leading medical staff services and provider enrollment.
CB: I began my career in healthcare completely by accident. A close friend was having staffing issues, and I had just relocated to the area. My background is in accounting, but she thought my skill set would lend itself nicely to her need for primary source verification (PSV). So, I jumped in to help. Little did I know that this would lead to a long career in PSV and PE. After several years working in PSV environment, the need to establish a better PE process for our organization was given to me. I created efficiency, training, and software systems that helped reduce the time to enroll with the payors. I now take both skills sets and work with symplr customers nationwide to help enhance both PE and PSV processes.
NAMSS: How did you get involved in the NAMSS Provider Enrollment Course?
MG: I applied to serve on the NAMSS Membership Committee to expand NAMSS’ reach to PEPs and other professions. As part of that work, I was asked to serve on the task force. I am thrilled to be a part of NAMSS’ increased focus on the PEP, as that is where I started my MSP journey.
CB: I attended a CVO symposium in California and, during that time, spoke with several member of the NAMSS staff who were thinking about providing NAMSS members with a robust PE knowledge base. I jumped at the opportunity to be included in this. I love the idea of sharing knowledge and creating a forum for folks to ask questions and collaborate. I have spoken at many different events over the years and love to share my excitement for and knowledge of PE with others.
NAMSS: What do you hope attendees take away from this course?
MG: Tips and tricks, pearls of wisdom, a sense of community, affinity, and a realization that we are all working together to promote safe, effective, and accessible care!
CB: My hope is that all attendees walk away with the tools they need to help them do their jobs with ease. I hope that contacts are formed so folks lean on each other when questions arise. Knowledge is the key to success.
Ready to add a new skill to your MSP toolbox or increase your current provider enrollment knowledge? Register now for the Provider Enrollment Course, kicking off during the NAMSS 44th Educational Virtual Conference and Exhibition. Purchase the entire series or enroll in individual sessions depending on what works best for you and your career path. Attendees who sign up for the entire series will receive a certificate of completion. With your registration, you receive access to the complete series of live and recorded sessions, along with the opportunity to earn 8.25 CEUs and a certificate of completion. Questions? Contact the NAMSS Education team at firstname.lastname@example.org.