Provider Relations Representative [Healthcare Compliance Tips]

Schedule a meeting with your insurance provider relations representative.

Did you know compliance issues can arise due to not understanding insurance contracts?  Do you know the name of your provider relations rep for each insurance company?

If not, today is the day to shift your mindset regarding the insurance company’s role in your practice, which starts with creating a meeting action plan.

In previous posts, we have suggested:

“Talk to your insurance provider relations representative regularly, since they provide more information than customer service representatives.  They help you understand your contract and provide tips or trends regarding the insurance company.  Schedule monthly or quarterly meetings to identify and remediate claims.”

Here are our thoughts on how to handle your interactions with insurance companies, such as:

• Internal Process

• • Organize a meeting.
    • Use this time to connect with your team to discuss any payment trends or issues that you are having with your contracted insurance companies.
  • Create a spreadsheet.
    • In the spreadsheet, include all trends and issues by insurance company.
  • Categorize by importance.
    • Take the information in the spreadsheet and categorize it by the most pressing issues/denials.
  • Schedule an appointment.
    • For each insurance company, schedule a recurring appointment with your provider relations representative.

• External Process

• • Form a connection.
    • Usually the representative’s goal is to help you understand their company’s insurance process. Therefore, form a real connection with them, which helps with communication and reduces conflict.
  • Share top pressing issues.
    • Due to time constraints, for each meeting, only collect 3 to 5 of your top pressing issues that you would like to discuss (with examples).
  • Ask questions.
    • This is the time to ask any questions you have about the payment process, contracts, resolution of outstanding claims/appeals, and much more.
  • Follow-up.
    • After the meeting, don’t forget to follow-up. Always reiterate what occurred in the last session and check to see if anything has been resolved on the insurance company’s side.
    • Use the information collected from the follow-up to assist with creating new policies, procedures, and trainings.

Remember, your goal is to form a genuine connection with your provider relations representative, so you can receive a clear understanding of their processes and fair compensation for services.

**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify, and tailor the advice to fit your specialty.