Thought Leadership

New Perspectives To Improve the Credentialing Industry

Billing Begins with Insurance and Provider Enrollment Verification

As seen in AMGA’s Group Practice Journal: Written by Patrick Doyle

Insurance verification plays an important role in a practice’s revenue cycle management efforts. When verifications are not managed properly, lost revenue can be significant. In addition to the provider’s time, other investments are at risk of being written off when a patient’s insurance is no longer valid, including materials and time spent on case preparation. This is why practices go to great lengths to ensure a patient’s insurance is verified well in advance of an encounter. If he or she isn’t covered, the procedure isn’t done.

While the financial implications of having to write off an encounter are well known, it is surprising that many practices overlook a process as important as insurance verification—provider enrollment verification. Similar to a patient not having valid insurance, when a provider is not properly enrolled with a health plan, his/her encounters will be written off. Given just how many patient encounters a provider has in a given day, week, or month, the financial impact can be significant. Yet few practices have processes in place for provider enrollment verification as stringent as insurance verification.

Insurance verification and provider enrollment are the start of the revenue cycle. If they aren’t viewed as such, they should be. When scheduling patients, provider enrollment verification must become a standard part of the scheduling process alongside insurance verification. When a patient isn’t covered, an encounter will not occur. Providers should follow this same process when an enrollment is not complete.


The full version of this article can be found in the June issue of Group Practice Journal, the flagship publication of AMGA. Please click here to view.

Newport Credentialing