Alyssa Lane
An insurance panel is a group of healthcare providers who work with an insurance company to provide services to enrolled clients. When an insurance panel is open, practitioners and groups may proceed with credentialing themselves with the payer. When it is closed, healthcare providers cannot submit an enrollment application. Insurance panels are usually open for a strictly defined period, and they close when insurance companies have an excessive number of participating providers. However, insurance companies typically re-evaluate their panels every few months, and there are strategies to negotiate access to closed panels.
| Characteristics | Values |
|---|---|
| Definition | An insurance panel is a group of healthcare providers who cooperate with an insurance company to provide services to enrolled clients. |
| Open/Closed Status | When a panel is "closed", healthcare providers cannot submit an enrollment application to the insurance company. When it is "open", practitioners and groups may proceed with credentialing themselves with the payer. |
| Open/Closed Factors | Insurance panels are usually open during a strictly defined time period determined by the payer. Panels may be closed when an insurance company has an excessive number of participating providers. |
| Application Process | Insurance companies require specific documents to be attached to enrollment applications. Once the application is submitted, the applicant must follow up with the insurance company to ensure it is received. |
| Contract | If the application is approved, the applicant must sign an enrollment contract with the payer, including an effective date and an individual provider fee schedule. |
| Closed Panel Strategies | It may be possible to get on a closed insurance panel by demonstrating unique value to the payer, providing extended hours, or referring patients from other practices on the panel. |
| Negotiation | Experts offer strategies for negotiating with insurance panels to get access to their members, such as demonstrating your unique value and utilizing "back door" methods. |
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What You'll Learn
- An open insurance panel allows healthcare providers to enrol and get credentialled with an insurance company
- Panels are often closed when insurance companies have too many participating providers
- To get on a closed panel, providers must showcase their unique value and appeal to insurance companies
- Patients can help their providers get contracted with insurance payers by nominating them
- National contracting experts teach negotiation strategies to get access to closed payer panels
An open insurance panel allows healthcare providers to enrol and get credentialled with an insurance company
An insurance panel is a group of healthcare providers who cooperate with an insurance company to provide services to enrolled clients. Healthcare providers can apply to enrol in an insurance panel and get credentialled with an insurance company. When a panel is "open", healthcare providers can submit an application to enrol and get credentialled with the payer (insurance company). Each insurance company or benefit plan has its own enrolment requirements and time frames for open panels. For example, some insurance companies may require specific documentation to be attached to the application.
When a panel is closed, healthcare providers cannot submit an application. Insurance panels are closed when an insurance company feels they have an adequate number of providers for a specialty in the area. However, this does not mean that providers cannot get on a closed panel. Insurance companies typically re-evaluate their panels every few months, so providers may be able to get credentialled at a later date. In the meantime, providers can appeal to the insurance company to make an exception, for example, by demonstrating their unique value or extended office hours.
If a patient wishes to see a provider who is not "in-network", they can request or nominate that provider to their insurance company. Providers can also ask for a single-case agreement, which allows them to become in-network for one specific patient. This can be a way for providers to showcase their value to the insurance company and potentially become part of the panel in the future.
Overall, an open insurance panel provides an opportunity for healthcare providers to enrol and get credentialled with an insurance company, allowing them to provide services to the insurer's clients.
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Panels are often closed when insurance companies have too many participating providers
An insurance panel, also known as a "payer panel" or "enrollment panel", is a group of healthcare providers who cooperate with an insurance company to provide services to enrolled clients. When a panel is "open", healthcare providers can submit an enrollment application to the insurance company and proceed with the credentialing process. When a panel is "closed", healthcare providers cannot submit an enrollment application. Insurance panels are usually open during a strictly defined time period determined by the payer.
If a provider encounters a closed panel, they have a few options. They can choose to accept the decision and file out-of-network claims, becoming a "non-par" provider. Alternatively, they can appeal the denial by crafting a compelling and fact-based case for their in-network status, such as showcasing additional training and credentials. Providers can also ask patients who are insured under the payer to contact the company and request or nominate them as a provider. This can help cut through the noise of other applicants.
To increase the chances of getting on a closed panel, providers should devote a significant amount of time to the credentialing process and present themselves as ideal providers who can offer unique benefits. They should also consider scouting out payers before beginning the credentialing process and putting extra effort into their applications for closed panels. Additionally, providers can offer extended office hours or weekend appointments, which may persuade the insurance company to open their panel to them.
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To get on a closed panel, providers must showcase their unique value and appeal to insurance companies
An insurance panel is a group of healthcare providers who collaborate with an insurance company to provide services to enrolled clients. When a panel is "open", healthcare providers can submit an application to the insurance company to become a participating provider. Conversely, when a panel is "closed", providers cannot submit applications, as the insurance company has decided they have an adequate number of providers for a specialty in a given area.
However, this does not mean that getting on a closed panel is impossible. Providers can still showcase their unique value and appeal to insurance companies to get on their preferred panels. Here are some strategies to achieve this:
- Negotiation Tactics: National contracting experts, such as Steve Selbst, offer training and webinars on negotiation strategies to access closed payer panels. These strategies include demonstrating your unique value, utilising backdoor methods to get into payer networks, and tailoring your negotiations based on network types.
- Extended Hours: By offering extended office hours or weekend appointments, providers can meet the needs of patients who may have difficulty accessing care during regular business hours. This can be a persuasive factor for insurance companies to make an exception and include providers in their closed panels.
- Patient Referrals: If patients insured by a specific payer request or nominate a provider, it can help cut through the noise of other applicants. Providers can ask patients to contact the insurance company directly or seek a single-case agreement, which allows them to showcase their value to the payer.
- Appeal Letters: Writing an appeal letter to the provider representative is a chance to make a case for inclusion in the closed panel. Providers should highlight their cost efficiency, efficacy, additional training, credentials, and any other factors that differentiate them from existing providers.
- Specialties: Providers can showcase their diverse specialties, such as orthopedics, sports medicine, or pediatrics, to demonstrate their unique value to insurance companies.
While these strategies can enhance a provider's appeal, ultimately, insurance panels may remain closed, and providers may need to wait for the periodic re-evaluation of panels or explore alternative options.
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Patients can help their providers get contracted with insurance payers by nominating them
An insurance panel, also known as a payer panel or an enrollment panel, is a group of healthcare providers who collaborate with an insurance company to offer services to enrolled clients. Healthcare providers must submit an enrollment application to the insurance company to be a part of the insurance panel. However, when a panel is closed, providers cannot submit applications.
Patients can play a crucial role in helping their providers get contracted with insurance payers. If a patient plans to see a healthcare provider who is not in their insurance network, they can request or nominate that provider to their insurance company. This is especially effective if the patient requires specialized treatment that is not available within the existing insurance network or if they cannot access appropriate in-network care locally. By nominating their preferred provider, patients can influence insurance companies to open their panels to new providers.
Additionally, patients can advocate for their providers by highlighting the benefits of their skilled care. This includes situations where the provider's treatment will help the patient avoid hospitalization or when the patient has recently switched insurance carriers. It is important for patients to recognize the influence they have in shaping payer-provider relationships. Patients can leverage this influence to ensure they have access to their preferred providers, even if those providers are not currently contracted with the patient's insurance payer.
Furthermore, patients can assist their providers in navigating the complex world of payer relationships. Patients can help providers identify the relevant payers for their services and understand the credentialing process required by different payers. This includes helping providers gather the necessary documentation and submit comprehensive enrollment applications. Patients with experience in the healthcare industry or those who have navigated similar situations may be particularly well-equipped to guide their providers through this process.
While it is the responsibility of healthcare providers to ensure they are contracted with the relevant insurance payers, patient involvement can make a significant difference. By nominating their preferred providers to insurance companies and advocating for their value, patients can help expand the range of provider options available within their insurance network. This benefits not only themselves but also future patients who share the same insurance payer.
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National contracting experts teach negotiation strategies to get access to closed payer panels
An insurance panel, or payer panel, is a group of healthcare providers who work with an insurance company to provide services to enrolled clients. When a panel is closed, healthcare providers cannot submit an enrollment application to the insurance company. However, there are strategies to negotiate access to closed payer panels.
National contracting experts, such as Steve Selbst, teach negotiation strategies to healthcare providers to help them access closed payer panels. Selbst has successfully negotiated over 15,000 payer contracts and is the inventor of RevolutionSoftware, a web service for payer contract analysis. He leads the "Blue Print for Success" Payer Contracting Class, which teaches medical providers how to negotiate payer contracts. The class is sponsored by medical associations such as the AUA.
In his training sessions, Selbst provides specific tools and tactics to help providers identify which closed panels are worth pursuing and how to get on them efficiently. Some of these tactics include demonstrating unique value to payers and using proposal strategies to open closed panel doors. Selbst's training is offered in various formats, including live webinars, CD-ROMs, and on-demand recordings, to cater to different preferences and ensure accessibility.
Other contracting experts, like Michael R. Lowe, Esq., and David J. Zetter, offer similar online training programs that provide step-by-step negotiation strategies for payer contracts. These programs aim to help healthcare providers increase their reimbursement rates, cut administrative burdens, and improve their contracting skills.
Additionally, there are several self-initiated strategies that providers can employ to improve their chances of accessing closed payer panels. These include networking with industry peers, showcasing additional training and credentials, and providing extended office hours or weekend appointments. Providers can also ask patients insured under a specific payer to request or nominate them as a provider, which can help cut through the noise of other applicants.
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Frequently asked questions
An insurance panel is a group of healthcare providers who cooperate with an insurance company to provide services to enrolled clients.
When a panel is closed, healthcare providers cannot submit an enrollment application to the insurance company as they are not accepting new providers. When a panel is open, practitioners and groups may proceed with credentialing themselves with the payer.
It can be difficult to determine upfront whether a panel is closed. You can try reaching out to local industry peers who have contracted with the payer or contacting the managed care team at a local hospital.
Insurance companies typically re-evaluate their panels every 2-3 months, so you may need to wait. You can also try to negotiate with the insurance panel to get access to their members. For example, by demonstrating your unique value to the payer.
Each insurance company or benefit plan has its own enrollment requirements, but the process usually involves gathering the necessary documentation, submitting an enrollment application, signing a contract, and becoming a participating provider.
