Written by: Ray Jorgensen, Co-Founder of PMG Credentialing

"Our health center needs to add providers fast and add them to our new clinic. Fast !!" 

Late last year an incoming email asked a simple question: Our health center needs to add 4 new providers quickly and add them to a new location. It seems like a simple, straightforward request that should be simple. However, the the reality is much more complicated. 

A Community Health Center in the midwest was adding a new clinic, in addition to expanding their roster of providers at the same time. The entire project needed to be completed in 60 days. While PMG Credentialing is used to having time constraints, this was a special case. The organization didn’t have any of the process started as both of their existing credentialing staff resigned unexpectedly. This health center needed assistance from beginning to end. The PMG Credentialing staff developed a plan dividing the issue into pieces and devoted staff to crafting a bifurcated plan: one for providers and the other for the clinic. 

On the provider side, the staff compiled the necessary source and supporting documents from three primary care providers and one behavioral health provider. PMG worked through the credentialing process and politely, but persistently, addressed one of the most time-consuming elements: obtaining references. Working with the provider and health center staff, it took only 4 business days, a lightning-fast result. Next up, insurance enrollment. This required significant & robust resources and time. The health center provided a prioritized list of payer applications:  “must-have” vs. “nice to have.” Applications were completed and submitted within one week. Follow-up was a multi-pronged effort with PMG and the CMO of the health center sending emails and making calls until the providers were approved. While the enrollment process is typically a ten-to-twelve-week process, and sometimes 6+ months, these providers were enrolled with “must have” payers in just 54 days. While prioritizing the “must have” payers, a secondary list was also fast-tracked. While all applications were completed and submitted within a week, the process secondary payer list took 71 days or just over 10 weeks. Still pretty quick turnaround by most standards.      

The clinic side process was, frankly, a bit cleaner despite unique requirements for each payer. The Medicare and Medicaid / MCO process was typically detailed and structured but commercial proved much more challenging. The applications for Medicare and Medicaid were approved within 44 days. This was quite fast as some of the information related to the encounter rate was submitted incorrectly due to a health center error. Thankfully the PMG team quickly during discovered the mishap during initial follow-up. A quick correction and the clinic location was approved. The commercial payers had unique requirements with some plans requiring a one-page addendum to their contract while others had a multi-page mini-applications to complete. The last carrier approval took 129 days which is way too long. However, PMG kept the health center informed all along the way and understood it was the payer approval process and timeline vs. PMG holding up final approval. 

 In the end, the health center leadership were quite pleased with the results. 

 During each monthly meeting with clients, the final questions always are:

1.      How many new providers are in the pipeline? And,

2.     Any new clinics opening up in the next 6 months?

 Pre-planning at this and other health center clients is the new status quo.