Broken Pathways of Payor Website Linking

Do you know when you are caught up in work, and then something moves so presently to the forefront of your mind that you cannot stop thinking about it? Well, for me, today it is Payor Website Linking. For the last 5 years of my career, I have become exposed to the numerous steps behind getting a provider/provider group successfully linked to a payor.

I have a regular arrival of mail that I find sitting on my desk each week. Over the years my team and I have slowly whittled it down to a small batch, but when I started it was mailboxes full. It begs the question, why has it taken so long for me to get this mail down to a manageable level?

Surely someone else with more payor enrollment and linking experience may read this and shake their head sympathetically at how hard I have made it for myself. It just was not part of my background, and that means I have to piecemeal learn it, to the best of my ability, as time permits.

For those other weary souls knee-deep in remits, paper checks, and documentation requests, I hope this quick article serves as hope that it can get better. Now, this is not about true Enrollment, the act of linking groups, sites, and providers to a payor, but there is some overlap. I have myself a fantastic teammate who manages this process on the front portions of linking, and then my team and I pick it up on the back end. I have also seen that based on a company's structure, this may be many people's combined roles, as opposed to my space where there are only 2 admins that manage it all. Find the people who can make it happen. It will take work, and more than one dedicated, organized, and proactive person on the job to make significant headway...but it can be done.

LYDIA'S TIPS FOR PAYOR LINKING

• When you set up a new group, a new TIN/EIN/NPI for a billing entity, do not submit the Medicare application until you have both (A) a lockbox address set up, and (B) w9 with a lockbox address. Seems odd right? We should just be able to update it later so that we can get the app submitted for the full 60 days before a go-live? We have tried both ways, and if you put a physical address, that gets uploaded, and all these other payors pick it up. Just try to change the flow of paper information from 1000s of payors retrospectively. It is not fun. This also means you need to be proactive with your finance and account teams, to get the bank account(s) and lockbox set up 90-60 days out from the client go-live. Otherwise, your enrollment team is going to be sitting on that Medicare app holding until they get those two critical pieces of information.

• If you change your bank, lockbox, etc. make certain you update the NPI website addresses (mailing and billing) before you start other changes with payor websites. It all has to match. And many payors use these public sites as their official listing, some even using it as part of their payor linking verification. I actually had one time where we had a lockbox change, and I was trying to update with the payor, and they would not approve the group's address for verification. I finally just asked, where are you getting this address from? It was the NPI website, and it had not been updated yet. So, if the bank and lockbox change, the team needs to change that address so linking is easier for verification.

• Website administration sucks, but someone has to do it. Always have two people at minimum that have administrative access to all the different payor websites. This is for two reasons, (A) So that there is backup if someone is out, and (B) to ensure that if access is lost, there is a backdoor in to regain access. For some of these websites it takes many calls, forms, and verification steps to get admin access. Once you have it, please make every effort not to lose it. Also please be a kind human and ensure you "pass it on" to another user before you leave an organization.

• Understand the difference between a direct payor website, verses a website that is a payor administrator. Some sites like Cigna or UHC have their own websites for primary functions of linking oversight; however, there are other sites like Availity, CAQH, Change Healthcare, Instamed, and Payspan that function as multi-purpose sites. Each site is different, with different functionality, and different linking capabilities for admins and users. Also understand how each of you billing or RCM vendor teams interact with these sites.

• If you are a multi-TIN (multi-client) linked administrator on a site, understand what granting certain access levels means to a user. Sometimes, you can stratify the access based on the TIN, but on certain websites, you may not notice you are granting certain access to all of your TINs. When in doubt, call the helpline and ask for clarification on what certain linking and levels of access are restricted to.

• Some sites charge fees for automated processing of EFTs, so review cost/benefit of this processing before you sign-up. Most RCM teams will know which sites charge for their premium websites or EFT processing. Usually it means things like more users, more reports, and faster processing timelines. However, most of these website also offer free/basic versions that will be just fine for most organizations.

There are probably many more tips I could think of around payor website linking. Things such as keeping up with payor website updates/changes, helpful reports to work with your RCM teams, or how to specifically work with various sites/payors. This space is one of those that changes as soon as you have figured it all out. So, keep at the tracking, be diligent, and you will get there, one piece of mail and one payor website at a time.