2026 Trends in Provider Enrollment Webinar Transcript
2026 Trends in Provider Enrollment
March 31, 2026
HealthStream released its 2026 Trends in Provider Enrollment Report to examine how enrollment practices shape financial performance, provider satisfaction, and operational efficiency across healthcare organizations. Drawing on findings from its ninth annual Provider Enrollment survey, the report explores how enrollment delays, fragmented structures, and manual workflows create downstream challenges that affect reimbursement, access to care, and organizational trust.
During the webinar, HealthStream leaders walk through the report’s key findings, highlighting the direct relationship between enrollment speed and provider satisfaction, the value of integrated credentialing and enrollment structures, and the growing need for disciplined process improvement as organizations expand across states and payer types. The discussion underscores how inconsistent data governance, lack of standard operating procedures, and limited visibility into financial metrics such as dollars on hold can widen the gap between enrollment effort and outcomes.
The conversation also looks ahead, emphasizing the importance of modernizing enrollment operations through better data stewardship, stronger collaboration across departments, and increased use of technology to reduce rework and revenue leakage. By grounding these insights in real-world examples and payer perspectives, the webinar reinforces the report’s central message: organizations that treat provider enrollment as a measurable, integrated, and continuously improving function are better positioned to accelerate reimbursement, strengthen provider relationships, and operate with confidence in an increasingly complex healthcare environment.
Access the full webinar | Download the 2026 Provider Enrollment Report
Timestamp Overview
[00:00:45] Housekeeping and Resources
[00:02:04] Agenda and Survey Purpose
[00:03:57] Why Enrollment Matters
[00:04:22] Audience Poll
[00:06:12] Key Finding 1 - Timing
[00:10:00] Payer Perspective Delays
[00:13:07] Structured Onboarding Questions
[00:16:09] Key Finding 2 - SOPs
[00:21:52] Data Governance Integration
[00:27:04] Key Finding 3 - Complexity
[00:29:54] Single Source of Truth
[00:35:31] Address Data Chaos
[00:37:53] “Effective Dates” Matter
[00:38:54] Multi-State Enrollment Risk
[00:41:06] Contracts and Delegation
[00:43:03] Tracking Revenue Leakage
[00:48:21] Payer Side Pressures
[00:56:01] Modernizing Rosters
[01:00:39] Wrap Up – Applying the Findings
[01:01:25] Closing
Disclaimer: This transcription was written by AI, thanks to Descript, and has not been edited for content.
Welcome to the 2026 Provider Enrollment Webinar
[00:00:00] Andrea Schmitz: Hello everyone, and thank you for spending some time with us today for our ninth annual Trends in provider enrollment webinar. HealthStream is the leader in healthcare workforce solutions. We help organizations work better by helping their people work smarter. HealthStream provides the leading, credentialing, scheduling, learning, and clinical development applications delivered on healthcare's number one platform.
[00:00:33] We streamline everyday tasks while improving performance, engagement, and safety. I'm your host, Andrea Schmitz, director of product Marketing at HealthStream, and I will be facilitating today's webinar.
[00:00:45] Housekeeping and Resources
[00:00:45] Andrea Schmitz: Before we begin, let's review a few housekeeping items. At the top of your console are buttons to display or hide the various panels Each panel is resizable and movable. Throughout today's webinar, please use those reaction [00:01:00] buttons, which I see everybody doing now. So thank you. That's great. to give us your reactions as we walk through the topics. we love that feedback. in real time, we encourage you to check out the additional resources located in your related content list on your console.
[00:01:16] This does include the name CE certificate for those of you who need that before you leave today. We'll also include that in the webinar follow-up email. you can also access your free copy of the 2026 trends and provider enrollment report by clicking on that download button. Lastly, we are recording today's webinar, and we will send you that link within a few business days.
[00:01:40] We have an exciting presentation for you today. So, without further delay, allow me to introduce your HealthStream speakers. We have Tammy Hawes, VP of Payer Credentialing and Compliance Solutions, Thomas Heitz, senior Consultant, and Katie Fox, senior Manager, clinical Solutions. I will now hand it over to Tom to kick us off and start with our agenda for today.
[00:02:04] Agenda and Survey Purpose
[00:02:04] Thomas Heitz: Thank you so much, Andrea. As you can see, we have a packed agenda. Today we are going to discuss elevating industry standards, getting to know you, our audience, our key survey findings, and how you can leverage the 2026 trends in provider enrollment report.
[00:02:24] The main goal of the survey now in its ninth year is to help elevate provider enrollment standards through identifying enrollment trends, providing metrics that can be used to evaluate your operations and to provide organizations with the data needed to help identify new initiatives or strategies. for those of you who have joined us in previous years, you are going to notice a few changes, this year, and we want to make this as interactive as possible.
[00:02:50] We encourage attendees to submit questions at any time using the ask question box on your attendee console. This allows us to address inquiries in real time and ensure your voice is part of today's discussion. Given the breadth of topics we'll be covering, please also use the reactions button docked at the bottom of your console to indicate interest in areas where you'd like to see the panel spend more additional time.
[00:03:17] Knowing that your executives rely on data to guide decision making and drive change. The 2026 report is now named the 2026 Trends in Provider Enrollment and includes the addition of a summary of key findings. These findings can be easily shared with your executive leadership. And while today's discussions will center around these five key findings, we encourage you to explore the full depth and of data available in the downloadable easy to digest report. You will also see that how we have written the report has changed and hopefully, it'll be very beneficial to you.
[00:03:57] Why Enrollment Matters
[00:03:57] Thomas Heitz: So, with all that out of the way, why is provider enrollment important? Enrollment is an important step toward achieving reimbursements and ensuring revenue for your organization.
[00:04:08] Delays or inaccuracies in provider enrollment and maintenance directly impact revenue. Making an efficient, accurate process critical.
[00:04:22] Audience Poll
[00:04:22] Thomas Heitz: So with that, let's get to know you. Here's our first poll question today. You can select the answer that applies to you by clicking directly on the screen and we just want to get an idea of what perspectives brought you to join our webinar today. Is it from a strategic ROI perspective for facility health system operations, operational insight for supporting this work slash provider enrollment, day-to-day management of this critical work or industry perspective and recommendations.
[00:04:59] We're going to give it a few seconds here. Hopefully we can get to 50% of attendees, before we move on because it's always interesting for us to get to know why you are here, so that we can speak directly to you. Looks like everybody's clicking and I can see about 25% have responded. 35% have now responded.
[00:05:53] Alright. It looks like the. number one reason people are here today is for operational insight for supporting this work slash provider enrollment.
[00:06:12] Key Finding 1 - Timing
[00:06:12] Thomas Heitz: All right, let's jump into our key findings. But before we do that, we are going to spend a lot of time today discussing physician satisfaction because ultimately their satisfaction is a powerful lever that you can leverage to affect meaningful change within your organization. The reality for many providers is that the enrollment experience is frequently the first operational interaction a provider has with your organization, health plan or network.
[00:06:42] What happens then when one organization has a formal process and the other one does not? In this first scenario, the provider could experience a smooth, transparent, and respectful enrollment process that signals that the organization values providers in turn that can then set your organization up for providers who are engaged (ie returning the things that you are asking them for and who are serving as advocates for your organization).
[00:07:10] However, we must not forget that on the flip side of this is a confusing or delayed process that creates frustration and mistrust before the relationship really even begins. Show me via a thumb sound if that is an option in the emojis. Who has experienced that latter situation throughout their career?
[00:07:30] I'm sure nobody on this call today has had that experience. If not, use the thumbs up button. If thumbs down is not an option.
[00:07:40] Katie Fox: Thumbs down if they've ever had providers expressing frustration with their enrollment process and a thumbs up if they've never ever experienced that. Tom, just to clarify
[00:07:51] Thomas Heitz: either one.
[00:07:53] Okay. They're definitely starting to see more thumbs down than, I had a feeling some people on this call might have experienced that, just a hunch I had. But it is nice to see though, that some of them have never experienced that. That is truly amazing. And I would like a list of the organization you work at.
[00:08:14] With this out of the way, I'm going to hand it off to Katie to lead us off with our first key finding.
[00:08:23] Katie Fox: Perfect. Thanks Tom. So, speaking of, enrollment time is a direct driver of provider dissatisfaction. Delayed enrollments leave behind a trail of frustration. And our survey results showed a very clear, statistically significant inverse relationship between the time it took to enroll a provider and respondent's overall satisfaction with the enrollment process.
[00:08:50] As enrollment times increased satisfaction levels, obviously decreased and research shows that a more structured onboarding processes are often associated with a higher satisfaction. Adding structure and streamlining processes between credentialing and enrollment can significantly reduce the amount of rework between departments while improving provider satisfaction and decreasing onboarding time.
Adding structure and streamlining processes between credentialing and enrollment can significantly reduce the amount of rework between departments while improving provider satisfaction and decreasing onboarding time.
[00:09:18] A couple tips that you can implement to further improve that would be implementing a single platform to manage credentialing and enrollment functions. It's a really great way to structure and streamline processes and share data. Sharing data then also allows some shared responsibilities like expirable management and long-term data maintenance, further reducing timelines.
[00:09:45] Another option would be consolidating applications. Applications. It can represent a significant strategic advantage as well if you're eliminating or reducing those provider touch points. How many times we're asking providers to give us the same information?
[00:10:00] Payer Perspective Delays
[00:10:00] Katie Fox: Tammy, I would be interested to hear your thoughts from a payer perspective.
[00:10:06] Tammy Hawes: Yeah, thanks for that Katie. I have spent time on both the provider and the payer side of the fence, and I think there's frustration on both sides. And my goal in life is provider payer collaboration, and that's a lofty goal. But from today, I'm going to talk a little bit from the payer side, and that might help some of our health systems and our providers out there gain some clarity into some of the challenges that they have.
[00:10:33] Most of the time, the delays on the payer side for processing applications and enrollment is really due to their own internal systems. A lot of the payers have acquired other lines of business and they have multiple systems and so they're typically not malicious. They just are challenged in their own way in taking the data from the applications for enrollment once they've received them, and then processing it, processing them.
[00:11:03] But things like incomplete submissions and missing data elements, that definitely adds time. And I think you can see that in the report where CMS, data cited, confirm this. The white paper also shows that more than 50% of paper-based applications trigger some kind of rejection versus if the payer has a portal and the provider submits a web-based application.
More than 50% of paper-based applications trigger some kind of rejection versus if the payer has a portal and the provider submits a web-based application.
[00:11:35] But I think that what payers are increasingly realizing is that the enrollment process creates their own compliance exposure around, network adequacy around provider directory. And, they are trying to come up with a way to make this process to easier. So really, from what I see, the delays hurt both sides of the equation and the financial, impact is really mutual on both sides.
[00:12:08] It's a little bit different for the payer and versus the health system, but they all have pain as it relates to this.
[00:12:23] Thomas Heitz: Thank you Tammy. Enrollment times for commercial delegated commercial non delegated and Medicare were all significantly negatively correlated with satisfaction of an organization's enrollment process. And you can see here, just how long some of those are taking. Obviously, Medicaid enrollment requirements vary by state providers may anticipate longer enrollment times.
[00:12:51] but we're really not sure why that one is getting a pass. So, if somebody has a thought on that, it would be great for you to drop that in the q and a [00:13:00] But as Katie stated, a more structured onboarding process is often associated with higher satisfaction.
[00:13:07] Structured Onboarding Questions
[00:13:07] Thomas Heitz: So, let's break that down a little bit, using a health system as our example.
[00:13:12] Some questions that you might want to start asking yourself at your system. Is everybody working towards the same start date? Is enrollment start date same as the credentialing team start date? Or are we all working off a different start date? Are the start dates realistic? I'm sure none of you have experienced when a recruiter, gives a provider a start date, two weeks from now, because that's what worked for the provider and we really wanted them to come to our organization.
[00:13:41] But obviously to get a provider credentialed or enrolled in that amount of time is probably not realistic. Do we know how long the credentials and enrollment processes even take? do we have a good handle on just what the timeline is? What is realistic? What percentage of providers are meeting those target start dates so that they can see patients, but also so that your organization can be reimbursed.
[00:14:06] I'm seeing a lot of laughing emojis, so I'm guessing a lot of these may not be happening. Were there any issues noted immediately that could result in a delay in either process? And the example I always like to give is a state license.
[00:14:27] Just one caveat; They don't actually have a state medical license for the state we are located in. And just a provider cannot see patients without a la license payers, whether it's commercial, Medicare or Medicaid, also require an active, valid state license before they will process or approve the enrollment.
[00:14:47] Is everybody working off that same set of provider data, like Katie talked about? Are we all in the same database or is the provider's data spread across three different systems or on a spreadsheet or siloed in just a myriad of ways within your organization? And does everyone have easy access to the provider data that they need to ensure their process can be completed in a timely, efficient manner?
[00:15:14] It obviously doesn't necessarily help you if the CVO has taken in all of the information you need for a provider, but it hasn't been shared out with the enrollment team so that they can begin their process. And then I'd like to pose, has your organization assigned a dollar amount to each day a provider's enrollment is delayed?
[00:15:36] This one gets a little bit tricky because obviously you need to have some of these other things in play, but we all know having. A conversation at the C-suite level. Finances can really help illustrate the point you are trying to make and to push change within your organization. I'll now hand it back to Katie to discuss our second key [00:16:00] finding that is all about how you can answer some of these questions and improve satisfaction in your enrollment processes.
[00:16:09] Key Finding 2 - SOPs
[00:16:09] Katie Fox: Thanks, Tom. Integrating department informal policies do drive higher satisfaction, and to speak to that a well-designed enrollment system, they're usually established through strong structure, clear policies, disciplined execution, and defined ownership, all of which contribute to improved stakeholder and provider satisfaction.
[00:16:33] In this industry, proper documentation is essential. If a process is not documented, it did not happen, or it does not exist. Therefore, it is hypercritical to formalize policies and procedures and to comprehensive standard operating procedures or SOPs. These SOPs should not only be developed, but also constantly and consistently maintained, communicated across all relevant teams and regularly updated to reflect any process changes.
[00:17:08] Some best practices for developing or even improving your standard operating procedures is to keep it clear and practical. Use simple and direct language to ensure that there's no room for misinterpretation and includes screenshots or examples. The next is to standardize the format with consistent templates across your organization to ensure they're easy to read, navigate, search, and of course, access doesn't do anyone any favors if they can't get the information.
Some best practices for developing or even improving your standard operating procedures is to keep it clear and practical. Use simple and direct language to ensure that there's no room for misinterpretation
[00:17:42] And then align your process with real workflows. Document what actually happens, not just what should happen, and then maintain and update them regularly by establishing periodic reviews and updates when processes, systems or policies change. And then train and reinforce, integrate your SOPs into your onboarding process and reinforce through ongoing training and audits.
SOPs are foundational in reducing variability, improving efficiency, and in ensuring that your processes are performed correctly every time.
[00:18:12] SOPs are foundational in reducing variability, improving efficiency, and in ensuring that your processes are performed correctly every time. Okay. And with that, I'll hand it over to Tammy.
[00:18:25] Thomas Heitz: Hold on. Before you hand it to Tammy. There is a good question in the chat about example of best practice SOPs.
[00:18:33] And I will say, obviously we can't necessarily tell you what would be best practice for your organization. I thought this could be an area we could talk about for a minute because I know in my past life I created an SOP that was basically reappointment from start to finish. And the whole point of that was so that regardless of who needed to do that process, or if I had a new person to start tomorrow, I could give them this book that had screenshots and everything they needed to complete that process from start to finish, hopefully with minimal questions.
[00:19:06] but do you want to talk about that as well?
[00:19:08] Katie Fox: Yeah. I would say any practice that you have should have a SOP to support it, whether it's initials, reappointment name change is the one that I love to pick on the most. Just because a provider changed their name does not mean we can just update it in the system.
[00:19:29] There are certain checks and balances that have to be updated and validated before we can simply just wipe out the last name and change it. You want to make sure that you have those standard operating procedures for any process, and that you have documentation to support it. It trickles into our workflow conversation about the process.
[00:19:52] But if there's ever an instance where you need somebody could question, or you need to ensure that particular task has been completed, you definitely want to make sure you have an SOP to speak to all of the steps included in that process, and that you have the documentation to support it, to ensure that you can prove that those checks and balances did occur.
[00:20:13] But yes, anything that you're doing should have an SOP and documentation to support that work.
[00:20:27] Tammy Hawes: Katie, I couldn't agree more with you and Tom and your assessment there. I would say from the payer side, it's a real structural advantage if they are working with a health system or provider group on a delegated agreement because they're checking to see about the provider group's organizational maturity.
[00:20:53] do they have the processes in place? Do they have the systems in place? Is there a clear, sense of ownership between enrollment and credentialing? Do they share data? Do they update their data? And I will say one more thing around the data is effective dates are very important as well.
[00:21:10] And sometimes, if you're making updates in a spreadsheet, you're not really tracking effective dates of different changes. I'd just throw that out there as well. But I would say for any organization that wants to be delegated with a payer, having all those documented workflows and the process for turnaround makes it not only easier to collaborate internally and it will actually help with the enrollment process and reduce friction, but it'll also make it easier to do the enrollment with payer and potentially, become a delegated provider.
[00:21:48] Tom, did you have anything to add to that?
[00:21:52] Data Governance Integration
[00:21:52] Thomas Heitz: Yeah, I will just say, obviously the integration of credentialing and a provider enrollment has been accelerating the past few years. I think this is
[00:22:00] something that kind of bubbles up to the top at every conference we go to. we're talking about it, or I'll see posts in various groups of I'm now in charge of provider enrollment and I've never done it before, help.
[00:22:11] but I think part of why this may be happening is because we are seeing a trend where organizations are looking to streamline all their vendors. We don't necessarily want to have one vendor for this person on paper. And they are all moving in as Tammy and Katie discussed into one software.
[00:22:33] but obviously in doing that, you open yourself up to a lot of conversations that need to be had around data governance so that you're setting your teams up for success in general. When we think of data governance and health systems, we often hear for the patient data and epic and things that physicians are doing, the credentialing platform is often not part of that discussion unless you've burst into that room and made it. One of the examples that I kind of always like to use when we're talking about credentialing and enrollment going into the same software is how they use physician specialty because how medical staff services uses that field and how enrollment uses that field is different. We now need to decide, okay, who's going to control that field?
[00:23:23] In my mind, knowing how important that specialty field is for getting paid on the enrollment side, it immediately becomes okay, enrollment now. Controls that field and those of us that have been MSPs and have worked in the medical staff services office, we need to be like, “okay, we're going to relinquish that and we're going to find another way to track what we need to do through board certification” or something like that.
[00:23:49] I think another big interesting thing that the three of us noted out of this survey that you can see here on the screen is that there is a good percentage of credentialing and enrollment living in the same software. But if you look at the internal health plan, it's only 6%. We don't necessarily know why that is.
[00:24:08] I know with a lot of the clients that I've worked with, it seems like the internal health plan is working in their own software. I wonder how long that will continue to be the case because obviously that means your organization has to support that software from all facets. Especially as we talk about the adoption of AI coming into play in enrollment and credentialing in theory, it could come into play there as well.
[00:24:37] Tammy or Katie, did either of you have any thoughts around that as well?
[00:24:43] Tammy Hawes: Oh, I'm a big proponent for shared data and systems as well so that the data just flows pretty seamlessly. Yeah, I can get in my soapbox about that, but I won't do that. I'll let Katie talk a minute.
[00:24:58] Katie Fox: I was going to say the same thing.
[00:25:00] We are all stewards of data. If you're using any data in any capacity, you are a data person and responsible for the data, and the accuracy of that data. It's not just Katie Fox is responsible for this one piece of data and she's the only one that can touch it. It really is a collaboration, which is why data governance is so critical.
We are all stewards of data. If you're using any data in any capacity, you are a data person and responsible for the data, and the accuracy of that data... It really is a collaboration, which is why data governance is so critical.
[00:25:24] we do need to make sure that we are all stewards of the data and ensuring data accuracy and data integrity, but we also have to understand ownership. Not to say nobody else can touch that field, but making sure that we have governance that can oversee that and ensure that the information that can, is contained in that one field truly is the information that should be there, right?
[00:25:49] There needs to be some data definitions and data standards to go along with that. I couldn't agree with you more, Tom.
[00:25:55] Thomas Heitz: and, Tricia called out in our Q and A about addresses.
[00:26:02] Thomas Heitz: We're not going to touch that, Tricia. But yes, we agree. We'd have to do a whole separate webinar on addresses, yes.
[00:26:09] And how to handle those, between enrollment and medical staff services. But yes, that is another huge area. But ultimately, what we're seeing here and what our survey data shows is that organizations that are combining credentialing enrollment within the same department are reporting significantly higher satisfaction with their enrollment processes.
[00:26:30] And that probably really goes back to, it's fostering better communication, more streamlined workflows, and they've probably implemented those formal data standards and policies that both Tammy and Katie alluded to that are so important. And ultimately, it just indicates that a structured, well-governed process will lead to better outcomes and a more positive perception of the enrollment function and realistically all the functions that are taking place here at your organization.
A structured, well-governed process will lead to better outcomes and a more positive perception of the enrollment function and realistically all the functions that are taking place here at your organization.
[00:27:04] Key Finding 3 - Complexity
[00:27:04] Thomas Heitz: Katie, do you want to kick off finding number three?
[00:27:07] Katie Fox: Sure. Process improvement is a priority for organizations with complex operations, so initiatives to improve enrollment processes for a principal concern for organizations. According to our data across all survey years, reducing the time required to enroll providers was rated the single most important process improvement initiative.
[00:27:31] Since this survey inception, which is our ninth year, a big deal is what we're hearing as complexities within the enrollment process increase. The need to standardize, organize, automate, and streamline becomes even more critical. And complexity demands discipline. Just couple areas that you can work to improve is to further streamline and improve efficiency within your organization.
[00:28:03] Again, establishing standard operating procedures to document the process and enforce adherence, that's huge. I can't recommend that enough. And then complex processes between health systems that cross state lines, or even, service systems. So if you have virtual care or health plans, each of those subsets come with their own complexities and most platforms now will allow for stacked applications so that providers can experience a single application view while meeting the requirements for multiple applications simultaneously.
[00:28:35] This becomes really essential for multi-state enrollment requirements, facility or specialty requirements, or even just the deviation between physician and non-physician practitioner specifications.
[00:28:58] We want to try and again, eliminate those touch points, and how many times we're asking providers for the same information. Consolidating or stacking applications is a really great way to reduce processing time as all the data elements are procured early and exist in the platform and can improve provider satisfaction by, again, reducing the number of those touch points, in which providers are contacted for redundant information.
[00:29:26] Thomas Heitz: Hey, Katie, there's a great example of what you are talking about in the chat about how about when enrollment, the enrollment team tries to enroll a provider that hasn't returned their medical staff application for clinical privileges. That really illustrates what you were just speaking about of how important it is to make sure everyone's on the same page and our processes are aligned.
[00:29:54] Single Source of Truth
[00:29:54] Katie Fox: And that kind of leads me into my next point with data accessibility. Maybe they did return that information and that information wasn't shared or isn't accessible to whoever needs it next. That's a huge call out. You're right. But referring to how easily users can find and retrieve that data and just making sure that data is accessible to those that need it when they need it, really helps to eliminate some of those barriers and delays.
[00:30:28] Also when, the data is hyper accessible in that fashion, decisions are able to be made faster because teams are more informed with the appropriate data, and teams spend less time searching and tracking down or just asking for that information. Again, ultimately eliminating a lot of rework or duplication in our processes.
[00:30:54] The other thing too is it will help to eliminate silos. I think a lot of times we think of onboarding in this little silo, and then we have credentialing in this little silo and then enrollment's all the way over here in their little silo. And really when there's a lot of steps that can take place simultaneously, so when information is shared or when it lives in a single source, it really helps to break down those silos and really foster collaboration and proving productivity and ultimately reducing errors.
[00:31:24] Again, I don't want to harp on a single source of truth, but really having a source, a single source of truth, the authoritative system or dataset or location that an organization truly relies on is having the most accurate and trusted version of data is really critical. And that certainly can help.
[00:31:45] When it comes to sharing data, though, I do just want to call out that it is important to have either sharing agreements and/or delegation agreements, may need to be established in order to share those specific data elements. Make sure that you guys are checking your bylaws. Check with legal.
[00:32:04] Just make sure that when you are starting to have those conversations about sharing data that you're legally able to do so. But when everyone's working with the same data, confidence and the accuracy in reporting improves. It directly improves and impacts your roster management and your provider directories.
[00:32:28] Those processes can become more streamlined, faster, more efficient, and eliminate, again, those multiple data entry points. I think I beat that one pretty good. Tom, Tammy, anything else you wanted to add?
[00:32:45] Thomas Heitz: Going back to that office example from earlier, when we think of a single source of truth, it's nice to think that we just have one single source of truth. And maybe it's our credentialing platform if everybody lives in there. But I think, our team can speak to when you are either going to new software or looking at your single source of truth, it is important to identify that everything may not be in the same software.
[00:33:17] Yeah, that may be the great ideal goal, but the addresses, they may only be right in your EHR. And they're not, maybe they're not right in your credentialing software or the enrollment team is using a completely different set of addresses.
[00:33:33] Thomas Heitz: I think that is definitely something I would call out for organizations to think about.
[00:33:37] And if you are thinking about different potential record areas, what is their single source of truth? And is it all leading back to one repository or are you leading back to multiple ones that, if you were gone tomorrow and you didn't have an SOP, perhaps somebody wouldn't know about.
[00:33:58] Katie Fox: Or a lot of times too, I think about those mental checklists, right? Whenever we're working with clients, I had a client I was working with, earlier this year and they said, “The workflow is missing all of these steps.” And I said, "Where are those steps?" And they're like, “I have a paper checklist.”
[00:34:18] Why do you have a paper checklist and an electronic checklist? Or, Linda just knows that you have to do X, Y, and Z. And I'm like, great. But that needs to be documented, right? We want to make sure we're streamlining those processes so poor Linda could take a day off. Or steps aren't being missed if Linda decides to go on vacation.
[00:34:38] It's really critical to ensure that you're right; all of the steps in the process live in one place. And you're right with data too. If addresses are pulling from the EMR in one area or the EHR in one area, and then from the credentialing platform in another, obviously there's room for some data cleanup and some standardization across the addresses.
It's really critical to ensure that all of the steps in the process live in one place.
[00:35:05] Tammy Hawes: Yeah. I was just going to add this finding here. Process improvement was a priority for organizations with complex operations. And, there are folks that say, “oh, we're simple. We can manage it in the spreadsheet.” But the reality is this is healthcare.
[00:35:24] There's nothing simple about it. And, again, people do want to take days off and that kind of thing.
There are folks that say, “Oh, we're simple. We can manage it in the spreadsheet.” But the reality is – this is healthcare. There's nothing simple about it.
[00:35:31] Address Data Chaos
[00:35:31] Tammy Hawes: And the question around the addresses, as you said Tom, is a whole can of worms, but I do believe that there are simple things that an automated system can do. Like USPS address verification.
[00:35:48]If an address comes in the street or st or whatever, it can correct that for you. So even if data's coming from multiple places or in multiple departments, it could be standardized once it's in a system. That's just something I thought of as it relates to the addresses, but there's a whole issue around practicing location addresses that we probably need to talk about as well.
[00:36:15] Thomas Heitz: And that's perfect Tammy because there actually is a question in the Q and A. Can you expand on the problem you most find with addresses? I'm sure Tammy could give us a three-hour presentation on what she has found throughout her career. I can speak to the system I was in.
[00:36:31] We were able to, as MSPs, enter in the address and that sounds great. But it's not great when I entered in one way and maybe I spell out street and then my colleague enters it another way and doesn't do that. And now we have the same address in our system multiple times. I'm sure no one on this call has experienced that.
[00:36:53] but the other thing we do see, to Tammy's point, as people want to take time off or come and go, how they manage the data in these systems probably also changes. And if you didn't have data governance before and it was just, I'm the director and this is what I decided we're doing. That works great until I'm not the director anymore.
[00:37:13] And then somebody new is coming in and there may be no documentation as to what we were doing, or they may just have a different idea of how things should look and be run. And if there are no SOPs or a governance committee or any type of checks and balances, what you will find over time in your databases is things get a little bit wonky.
[00:37:36] as I like to say, just those kind of unintended consequences, I guess would be a nice way to put that. Katie, Tammy, anything you'd add to that? I
[00:37:53] “Effective Dates” Matter
[00:37:53] Tammy Hawes: Yeah, I see a question around the effective dates with various payers for the addresses, because that is something they have on their side, which is, another reason I talked about the effective dates on every piece of data that you have about a practitioner and a location. That's extremely difficult to do in a spreadsheet.
[00:38:18] Thomas Heitz: and I will say too, even if you have a software platform, if you're not populating your effective or renewal dates, you then can't use an automation piece to go out and look and tell you who's upcoming or present you with a list.
[00:38:31] so it's kind of almost like being back in the spreadsheet and you having to hope you don't miss anybody.
[00:38:37] Tammy Hawes: Exactly.
[00:38:41] Thomas Heitz: All right. Katie, do you think we've covered this topic enough? Should we move on a little bit?
[00:38:54] Multi-State Enrollment Risk
[00:38:54] Thomas Heitz: Obviously multi-state operations also create unique challenges for provider enrollment. However, let's just focus on Medicare and Medicaid here for a moment. As we can see from the survey data, 56% of survey respondents are managing Medicare enrollment in more than one state with 8% managing it across all 50 states and or U.S. territories.
56% of survey respondents are managing Medicare enrollment in more than one state with 8% managing it across all 50 states and/or U.S. territories.
[00:39:19] When we look at Medicaid, 64% are managing enrollment across more than one state with 7% managing it across all 50 states and or US territories. Medicare enrollment requirements are largely standardized nationwide because Medicare is a federal program. When you are discussing parts A and B, however, limiting variability driven enrollment risk, however, the regional administration and Medicare Advantage Part D, Medigap participation introduce payer and state level differences that can affect contracting timelines and revenue activation.
[00:39:59] On the other side, Medicaid presents significantly higher enrollment and revenue risk, given that the requirements, systems, timelines, and compliance obligations vary from state to state. This variability obviously increases in organization's likelihood of enrollment, delays, denials and rework, directly impacting provider billing timelines and cash flow.
[00:40:21] So that's really going back to finding one and then obviously staying within this finding. Obviously I don't personally want to imagine doing Medicaid in all 50 states. That is going to present a lot of complexities for your organization and being able to track all that.
[00:40:43] There's just so many complexities that organizations need to be aware of and to plan ahead of time for, given that we continue to see health systems expand into different states and markets as seen in our survey data, it is now the minority that are only doing one state.
[00:41:06] Contracts and Delegation
[00:41:06] Thomas Heitz: Timmy, how do these complexities play out when it comes to payer contracts and delegation agreements?
[00:41:13] Tammy Hawes: What we find is that, typically each state Medicaid program is essentially a separate payer even with inside an MCO and they have different requirements, different timelines, but the data's the same usually. There may be a state that requires information that another state doesn't require, but I guess the key is that if you have a more single source of truth for your data, then you can populate that to whatever payer network or onboarding process that you need to. I think what was interesting in this finding, that 64% of enrollment leaders review a payer contract before signing and 53% are involved in the delegation agreement before signing.
64% of enrollment leaders review a payer contract before signing and 53% are involved in the delegation agreement before signing.
[00:42:00] That's, that only makes sense because they need to know what they're getting into. From an operational standpoint, I was kind of shocked that what's the other 47% doing, just finding out after the fact and the other 36%. That was a little bit shocking to me. I think that if you have the complexity that we talked about before, that forces a lot of these, changes and the seriousness of people to really look at how do they, resolve their provider enrollment problems that may not occur in, an organization that think they have an easier, arrangement or easier set of data on the provider side to manage.
[00:42:54] Thomas Heitz: those, are those unintended consequences for the ones not doing this? Tammy?
[00:42:58] Tammy Hawes: Yes.
[00:43:03] Tracking Revenue Leakage
[00:43:03] Thomas Heitz: For those of you who have joined us in previous years, this is my soapbox, that I usually get up on, when we're talking about financial tracking, correlating with the perceived importance of financial outcomes. And like Tammy, we'll get into this data a little bit more on the next slide.
[00:43:22] I'm always surprised when I see this data. I shouldn't be at this point having done this for several years now, but it just surprises me every time. Let's talk a little bit about what this year's data actually showed. In 2026, 49% of survey respondents stated they did not have access to the on hold data.
In 2026, 49% of survey respondents stated they did not have access to the on hold data... And while this is an improvement from 64% in 2023, 50% of survey respondents also said they did not have access to provider enrollment claims write off data.
[00:43:43] And while this is an improvement from 64% in 2023, 50% of survey respondents also said they did not have access to provider enrollment claims write off data. Now, that is also improved. It's down from 70% in 2023. So we are seeing some improvement here, but these are still over 50%. So we're talking about 50% of the people doing this work do not know what amount of claims are on hold or even being written off at their organization.
[00:44:22] And just it's, there's still too many individuals without access to this information. This information is vital for so many reasons, but obviously we need to know this information to ensure revenue continuity and any organizations that are providing a. Onboarding program, should really be looking to see how they can use this information to assign a dollar amount to the delays for providers.
[00:44:58] If we are, say for example, writing off half a million dollars in care every year without knowing that's the amount we're writing off, there's no way I can know if my process is broken and the process that I'm managing is broken. Maybe it is something I can change, maybe it isn't, but I need to know that's what we're writing off.
[00:45:24] And then I need to make adjustments to my process and see if that number goes down or if that number goes up. That's going to be your direct correlation to say, “Hey, what we are doing here is working. We now only wrote off $250,000 this year, and then next year our goal is to get that down to, below a hundred thousand.”
[00:45:42] It's almost a bit of a secret among organizations. Nobody wants to share this information. Nobody wants to talk about this information. We do have people in our survey who select that they don't feel comfortable sharing this information, but I just think it is so important for organizations to share this and to bring it out into the light, bring it out into the open. Because if we're not doing that, it's really hard for us to have a conversation about what may or may not be working for our organization.
[00:46:16] And like I said, if you can tie back a dollar amount, then that gives your office an opportunity to clearly demonstrate, what we are doing is important and this is the direct outcome of the work we are doing. We are now protecting this revenue for the organization because otherwise, the C-Suite is just seeing it.
[00:46:38] As a red line on the overall budget that we'd like to gloss over because that's not so good, but it really is important. And when we start really looking into this data, you can see that there are still organizations that 11% that aren't even tracking this data. That is just wild to me without that you don't know what is or is not working.
[00:47:13] And there is just so much revenue you're probably letting walk out the door that you don't even realize. I think also as we hear more and more about AI coming into enrollment and credentialing, this may be an opportunity where AI can help us solve some of these things and look at it.
[00:47:34] I know when it comes to credentialing enrollment, often what we hear, as those doing it is, AI can replace you. I think, given the amount of time we've spent today talking about data governance and having an accurate data set, I think that's going to be a hard sell because AI needs data to learn.
[00:47:53] And if the data we give it to learn is crazy, what it's going to learn is going to be crazy. But I think there are really interesting and important ways we can leverage AI as we move into this in ways that will be beneficial to us and can help us prove that what we're doing is important, and that there is value in it.
There are really interesting and important ways we can leverage AI as we move into this [enrollment and credentialing] in ways that will be beneficial to us and can help us prove that what we're doing is important, and that there is value in it.
[00:48:15] Tammy, anything you would like to talk about as far as the payer perspective in all of this?
[00:48:21] Payer Side Pressures
[00:48:21] Tammy Hawes: Yeah, I would say that for a payer, many of them are now being mandated to enroll in credential within a specific timeframe, especially in some state Medicaid programs. There's one state I know of that after the application is submitted that they need to pay the provider, at least pay them out of network within the first five days of a clean application.
[00:48:49] So basically they would be out of network and or non-par and then they would switch to participating once all paperwork came through on the credentialing process. What this means is their timeframes are shrinking too. Now, I know there's been some comments out there around payers not responding appropriately and constantly having delays, and we can't make any excuses for those payers.
[00:49:15] But also we can't make excuses for a health system or provider that constantly submits that data. There are problems on both sides. I think that on the payer side, their dollars on hold problem is a little different because when a claim comes in for providers that aren't fully enrolled, they have to pin them, kick them out, or then do outreach efforts or deny the claims and reprocess them once the enrollment is completed.
[00:49:47] And this is extra cost on their side. In fact, I heard another study where it estimated at least $25 per claim for every claim that had to be reprocessed at a payer. So that's real cost. The payer has their own operational metrics, at least the good ones do around clean claim rates first, pass resolution, enrollment gaps.
Estimated at least $25 per claim for every claim that had to be reprocessed at a payer.
[00:50:09] And, they're also big into looking at delegated credentialing arrangements, which would really put the focus on the health system or the provider group to ensure that the their provider data is good, the providers are credentialed, you have effective dates, and you submit things cleanly. I think that, measurably, it probably feels more painful on the provider side.
[00:50:43] I know there's more providers on this call, but there's quite a bit of payers, but there's a lot of pain on the payer side as well. If these considerations aren't taken seriously, just imagine how much money we could save across the board,
[00:50:58] Tammy Hawes: Yes. And redirect that to patient care. I'm a big advocate for reducing admin costs and redirecting it to patient care.
[00:51:09] Thomas Heitz: Yep. Work harder, not, work smarter, not harder. There's a great comment in the chat too about, obviously, we've all heard the saying,”junk in, junk out, junk in, junk out” when it comes to data. And obviously that's going to apply. If you're just adding AI in there, you're going to get those same results.
[00:51:30] And I think that's something that we've all been aware of for a really long time. I know I participated in cleanup efforts at my organization; we still see them today. How do we really get this data that's so important, cleaned up and standardized?
[00:51:50] Anything you'd add to that, Katie?
[00:51:54] Katie Fox: I always say yes, that task is very daunting, but how do you eat an elephant one bite at a time? It's really discouraging when you look at the project in its entirety. It's easy to just become inundated with the vast, like the bigness of all of the data that needs to be cleaned.
[00:52:19] But if you start small, right? I know Tom, you and I have talked about this before, but when you start with one file, every time you touch a file check X, Y, and Z field to make sure that those are updated. After a while, it seems like it's not making a huge difference because we may only be touching 30-40 files every day, but after a couple months, we're going to see major improvements in the quality of that data and the consistency in how it's stored and maintained – which is huge.
[00:52:47] So it doesn't have to be “Everyone's working 16 hour days for the next month to get that data cleaned up.” That's just not realistic, right? But small change can have really great impact.
[00:56:01] Modernizing Rosters
[00:56:01] Katie Fox: Maintaining timely and accurate rosters is a critical component of ongoing enrollment operations. Electronic methods can help teams to better meet and maintain these roster demands, but based on our survey results, this graph clearly shows that the majority of survey participants are providing rosters via email or other electronic means.
[00:56:22] I personally would suspect that over the next few years with the advancements in technology and integrations that we may see a shift from email-based submissions to a API or SFTP or other integrated methods, further improving the automation and efficiency. Of course, that would be dependent on the quality of the data.
I personally suspect that, over the next few years, with advancements in technology and integrations, we may see a shift from email-based submissions to API, SFTP, or other integrated methods—further improving automation and efficiency.
[00:56:50] In the meantime, while we're still sending those reports via email, there are several opportunities to improve some of the operational challenges for roster management. Data quality, obviously, number one, we do want to make sure that your source data is clean and accurate. because that, and that really truly is the most prominent challenge I think, we all face.
[00:57:14] As discussed, implementing a data governance committee to establish data standards and data definitions is critical to enforcing and maintaining data integrity. It does sound like a daunting task. I know we just chatted about it because it is a daunting task. It's huge. So again, start small, build out your data definitions gradually, and eventually you'll have standardized guidelines for your data repository and clear definitions for data entry, your source of truth.
Implementing a data governance committee to establish data standards and data definitions is critical to enforcing and maintaining data integrity.
[00:57:42] Maintaining that data in a single source is a huge benefit, often resulting in significant reduction in time. Also eliminating some manual management and most importantly, eliminating errors. Building reports or establishing templates are also great ways to eliminate and/or prevent manual manipulation and sometimes, eliminating all that manual manipulation altogether.
[00:58:07] and I just want to be cognizant of our time. I know we're getting close, but Tammy, did you have anything else you wanted to add?
[00:58:15] Tammy Hawes: Yeah, I just wanted very quickly say yes to everything you said and also just, say that the regulatory requirements that are coming down for the payers on how fast they need to update their provider directories, it just can't be done in a manual world.
[00:58:32] the clock starts ticking as soon as they receive the change from the provider broker health system. And one of the biggest issues right now with provider data in the provider directory world is provider location changes when they terminate and they move locations. Because that's what creates what we've heard of is ghost networks or ghost providers when they're not actually practicing at a specific location. I'm a big proponent on doing this electronically with APIs. rosters are probably better than manual form, but I think all of those we are going to see go to API in the next couple of years. And there's a lot of, investment the payers have put into the infrastructure to be able to handle that.
[01:00:39] Wrap Up – Applying the Findings
[01:00:39] Thomas Heitz: How can you leverage the findings at your organizations? Consider how these insights can be communicated within your organization, taking into account your culture, its mission, and your strategic priorities. I really hope you enjoyed this new format this year, and we would love to continue this conversation with you.
[01:00:58] Please check out the related content on your attendee console or connect with us directly. Just as a reminder, today's takeaways will be the slides, our word cloud, your NAMS credit, and a copy of the 2026 Trends in Provider Enrollment report, that you'll receive via email following today's webinar.
[01:01:20] And with that, I will hand it back over to Andrea.
[01:01:25] Closing
[01:01:25] Andrea Schmitz: Thank you, Tom and Tammy and Katie, for all your great insight and conversation today into these key findings. Before we close out, we wanted to let you know that HealthStream will be at the upcoming conference in Las Vegas in June. So, if you or your colleagues are headed there, please encourage them to stop by our booth.
[01:01:47] We'd love to connect. Thank you again for attending today's webinar. Please take a moment to complete that feedback survey on your way out. As a reminder, in the next few business days, you will get that follow up email that Tom outlined, which will include a link to today's recording. Thank you again for supporting HealthStream and today's presenters, and have a great rest of your day.
[01:02:09] Katie Fox: Thank you.