Enroll with payers sooner. Maximize reimbursement.
Provider enrollment allows you to submit electronic data interchange (EDI) transactions
to payers and get reimbursed for your services.
Provider enrollment is the process of adding a provider to commercial and/or government health plans so that the provider/practice can be reimbursed for services provided to patients.
To join a commercial health plan, the provider must follow the payer’s specific application and credentialing process. If the provider is approved and signs a contract with the health plan, the provider will be considered “in-network.” This is very exhaustive work, yet the credentialing process is even more strict and detailed for enrollment with government health plans like Medicare and Medicaid.
Most patients will not seek care from an out-of-network provider. Provider enrollment is therefore not only essential to getting paid but also for attracting patients.