Life Amid COVID: Efficiency Impacts on Provider Enrollment and Credentialing

When COVID-19 hit, process changes had to be implemented across many fields of work. Workplaces making accommodations for employees to work remotely from home was just the beginning. This drastic change caused businesses to re-evaluate how their processes and business goals could be accomplished.

When companies began determining how their work requirements could be completed with employees working remotely, they quickly realized that reliance on technology would be essential. Provider enrollment was one area of our workforce that was impacted and made changes to processes to support a new environment.

To get an understanding of how the changes impacted some working in provider enrollment, Donna Butcher had a Q&A with Michelle Romero, Credentialing and Billing Coordinator at Huntsville Hospital Health System in Huntsville, Alabama. Michelle has worked for Huntsville Hospital since 2008 and specifically in the credentialing and enrollment department since 2011. She is part of a team that completes payer enrollment for approximately 400+ providers. Michelle has witnessed the change in the enrollment processes through the pandemic and agreed to share her thoughts on this.

What was your payer enrollment process pre-COVID?

Our payer enrollment process pre-COVID, I felt, was much more secure and timely. Most applications for payers were submitted via fax, email, and/or USPS. We felt confident in knowing payers would process our applications in a timely manner. If enrollment specialists had payer questions, we could quickly call and obtain an answer. We also worked in the office having full access to all files and information needed as well as the equipment and tools we used.

Did COVID-19 bring many changes and/or stresses to your department?

COVID put a strain on our enrollment process. Our hospital continued hiring new providers, and APP's but the expectation was the same - "hurry up and get them enrolled." From a Managerial standpoint, there was not much support due to the demands being placed on all areas within the organization. As a Credentialing/Enrollment Specialist the pressure weighed heavily on our team. Some employees were given the opportunity to work from home, while others were not. Our department moved very slowly and when COVID hit a critical stage – some were required to continue working at the hospital. Those who were required to come in felt stressed finding the balance of working in person while their family was home. Those that did work from home a few days a week also felt the stress. This was particularly evident for those who had children learning virtually while employees were trying to assist and work, sometimes at the same time.

Did payers make changes to processes such as verifications, how applications were submitted or communications?

Most of the payers had their employees working remotely. There were many days, our phone calls were not answered or there was so much background noise you could barely hear the representative. There were problems with the faxing of applications. Most payers requested we fax our applications in addition to emailing. However, the payer’s employees were working from home and could not access the received faxes. This caused a prolonged enrollment process. We never really knew when the approval would be received. There were many different answers out there, leaving our team worried. Things were very inconsistent. Some commercial payers were doing "instant" enrollment via phone and some allowing applications to be sent via email. Medicare made COVID previsions - they enrolled a provider without much of the regulatory information typically requested on a normal submission. Little to no verifications were performed. Alabama Medicaid was also very helpful during all the changes. A few of their employees went above and beyond to make sure our enrollments were processed in a timely manner.

Have payers kept any process changes, or have they return to all their pre-COVID processes?

Payers returned to requiring paper application or an online submission of an enrollment application once the COVID protocols expired. I am not aware of any payers allowing for implementation of COVID process changes as a new policy. If anything, I think it revealed the vulnerabilities within each organization, opening the door to work on areas for improvement going forward. Our hospital, in particular, did not modify how we move forward in the future.

Do you feel that COVID made payer enrollment easier or more difficult to complete within your health system?

COVID made enrollments more difficult, for all of the reasons I mentioned previously. I think it is safe to say, not all payers, or our department, were prepared for such a break/interruption in their system. I know we are still making updates. Our cyber security is still continually requiring updates.

One last question Michelle. Are there any process changes that payers made that you wish would have remained?

COVID created such uncertainty with the enrollment process, I can say that I am thankful we were not any of the thousands of people who lost their job during this time and have an opportunity to work on our processes going forward with our staff.

COVID changes affected many areas of our workforce. We are still feeling the effects today. Will things ever go back to the “way they were”, that is unlikely. But I think we did get one positive out of all this. We have learned to live an adaptive life both personally and at work.

I would like to thank Michelle for taking the time to speak with me on this subject when I know she is extremely busy. And wish her the best.