Elevating Provider Experiences: Mastering Enrollment from the Start

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(In this first installment of our four-part series on Provider Experiences, we explore the crucial strategy of getting enrollment right from the start.)

Provider enrollment is often time-consuming and complex. Our analysis shows providers typically have several clicks or pages to navigate before reaching the enrollment application. Completing the application can take as much as two hours, 18 steps, and 150 fields. Steps within steps add more complexity and frustration. After all this effort, applications are often returned because information is incorrect or missing, requiring resubmission.

States with intelligent provider solutions can analyze data to pinpoint friction during enrollment. For instance, it helps to know the average number of submissions to complete an application, which questions are answered incorrectly or left blank, and how often applicants contact the call center — and why. It’s also insightful to know return to provider (RTP) metrics by provider and specialty. Fast, first-pass provider enrollment can help end this cycle of inefficiency.

Streamlining the Enrollment Process: How Screen Guidance and Checklists Enhance Provider Experience

Screen guidance and a pre-enrollment checklist can greatly improve a provider’s experience when completing an enrollment application. Screen guidance offers step-by-step instructions, reducing confusion and errors, while the checklist helps providers prepare all necessary documents in advance, speeding up the process and minimizing delays. Together, these tools make the enrollment experience more efficient and user-friendly.

Optimizing Provider Experience: Seamless Enrollment with GUI, Auto-Fill, and Unified Views

By shifting the mindset from traditional UI (User Interface) to a more intuitive GUI (Graphical User Interface), providers can have a significantly smoother experience when completing an enrollment application. This evolution includes features like dynamically rendering applications and auto-filled, pre-validated data, reducing the need for repetitive data entry and minimizing errors. With automated, “one-click” processes, providers can quickly complete tasks with a single action, further streamlining the experience. Additionally, a unified and integrated experience allows providers to view all relevant information in one place, eliminating the need to navigate multiple screens or systems. These enhancements create a more efficient, seamless, and user-friendly enrollment process, saving providers time and reducing frustration.

Streamlining Provider Enrollment: The Role of Bulk Uploads, Auto-Enrollment, and Data Automation

Bulk uploads can speed up application data entry. Through the use of templates and bulk uploads, organizations can limit data entry and submission of multiple applications by performing many tasks at once. For example, organizations that continuously enroll similar providers into their group may only need to enter the shared office information into a provider enrollment template once, then apply it to all to reduce manual data entry.

Some states are implementing auto-enrollment for simple application types and using automation to process certain specialties. For example, in Colorado, primary care providers are auto approved during the enrollment process. States and solution providers are also expanding opportunities to prepopulate enrollment application fields with third-party data from highly qualified national registry sources that simply need to be validated by the applicant.

Vermont’s Success: Reducing Medicaid Provider Enrollment Time by Over 90%

How extensive can these benefits be? Consider the case of Vermont, which implemented Gainwell’s Medicaid Enterprise System (MES) Provider Solutions in response to a high-priority legislative initiative to reduce the enrollment timeframe for Medicaid providers. The project’s original goal was to reduce the average provider enrollment timeframe from 120 days to less than 30 days. The approach exceeded the original goal by processing 100% of all applications under 30 days since implementation while utilizing 36% fewer staff.

Vermont was able to:

• Decrease average provider application time from one to two hours to 15 minutes
• Decrease average application screening time from more than one hour to 20 minutes
• Initial 150% increase of monthly enrollment and revalidation processing, which continues to be maintained

Conclusion

Enhancing the provider experience is essential for improving the efficiency and effectiveness of Medicaid services. By focusing on key elements of the enrollment application and simplifying the overall process, we can significantly improve the provider journey, resulting in better outcomes for both providers and members.

Look for our next installment of our series as we focus on simplifying the revalidation process. For a deeper dive on a friction-free provider experience, read our white paper or contact us for more information.