Thought Leadership

New Perspectives To Improve the Credentialing Industry

Q&A: What is a Par – Non-Par Analysis and Why Is It Important?

Allyson Schiff, Vice President of Operations, discusses the role of the Par – Non-Par Analysis and why it should be a critical part of your credentialing life cycle.

 
Q. What is a Par – Non-Par Analysis?

A. A Par – Non-Par Analysis is the process of validating your provider’s enrollment data with the insurance plan(s). Known as a Participating and Non-Participating (Par – Non-Par) Analysis, it is the process of validating the participating status of each of your providers across all plans, locations, and Tax IDs. (This can also include specialty and taxonomy code.)

 
Q: Why is a Par – Non-Par Analysis important?

A. A Par – Non-Par Analysis is critically important in that it allows you to create a baseline of who your providers are enrolled accurately with and who they are not. By establishing an enrollment baseline and identifying which providers are NOT enrolled with your plans, you can take pro-active steps to enroll your providers with all of your plans, locations, and Tax IDs.

 
Q: What are some benchmarks that can be followed when conducting a Par – Non-Par Analysis?

A. The basic benchmark to follow when conducting a Par – Non-Par Analysis is: Total Providers * Total Plans * Total Locations. Here is an example:

1. Total Providers – 100
2. Total Plans – 25
3. Total Locations – 10
4. Total Participating Opportunity – 25,000 PINs

 
Q: When conducting a Par – Non-Par Analysis, what is the easiest way to process them?

A. The simplest way is to request rosters from your insurance plan(s). You should ask them for the participating enrollment data that they have for all of your providers, locations, and Tax IDs, specialties and taxonomy codes. When you receive the rosters back, compare the results to your actual providers, locations, and Tax IDs and identify the mismatches. Once the mismatches are identified, initiate enrolling or linking your providers to the missing locations, or Tax IDs.

Another way of conducting a Par – Non-Par Analysis is to contact the payer(s) by telephone. In these instances, you should contact the payer(s) representative, request the current enrollment status of your provider(s) for each location and Tax ID, and compare that to what you believe should be your full enrollment status.

 
Q: How frequently should I conduct a Par – Non-Par Analysis?

A.We recommend conducting a Par – Non-Par Analysis on a quarterly basis.

Conducting a robust Par – Non-Par Analysis is key to ensuing that the enrollment data that you have corresponds to the enrollment data that the payer(s) have. If you do not conduct this analysis, you may be losing revenue and causing patient dissatisfaction.

Download

Click here to download the PDF.

 

Newport Credentialing