Payer Enrollment for Telehealth

Enrolling as a telehealth provider with insurance payers involves unique steps and documentation. Each payer—Medicare, Medicaid, and commercial insurers—may have different requirements for credentialing and billing telehealth services. Understanding these differences is essential for timely enrollment, compliance, and successful reimbursement.

What Makes Telehealth Payer Enrollment Different?

• Location and Address Requirements: Some payers require a physical practice address, even for telehealth-only providers. Others may allow a home office or virtual address, but requirements vary by payer and state.

• Telehealth Attestation: Many payers require you to complete a telehealth attestation or provide documentation confirming your ability to deliver compliant virtual care.

• Service Codes and Modifiers: Claims for telehealth services must use the correct CPT/HCPCS codes and telehealth-specific modifiers to ensure proper processing and reimbursement.

• State-Specific Rules: Medicaid and some commercial payers may have additional or unique requirements for telehealth credentialing and billing.

Key Steps for Telehealth Payer Enrollment

1. Review Each Payer’s Policies: Carefully check the telehealth credentialing and billing requirements for every payer you wish to enroll with. Requirements can differ widely.

2. Complete Required Attestations: Fill out any telehealth-specific attestation forms or supplemental applications required by the payer.

3. Verify Practice Address: Ensure you meet the payer’s requirements for a physical or virtual practice location. Avoid using P.O. boxes or unregistered addresses.

4. Submit Accurate Documentation: Provide all requested documentation, including proof of licensure in each state where you will serve patients, technology compliance, and telehealth policies.

5. Update as Needed: If your practice expands into new states or changes telehealth platforms, promptly update your payer records and credentialing files.

Common Pitfalls

• Mismatched Addresses: Using a P.O. box or virtual office address that doesn’t meet payer requirements can delay or deny enrollment.

• Incomplete Documentation: Missing telehealth attestations, technology details, or licensure information can result in delays or denials.

• Ignoring State-Specific Rules: Failing to comply with unique Medicaid or state insurance requirements can jeopardize your ability to bill for telehealth services.

Best Practices

• Keep a Checklist: Track each payer’s telehealth enrollment requirements to avoid missing key steps.

• Communicate Changes: Notify payers immediately of any changes to your practice location, licensure, or telehealth services.

• Stay Informed: Telehealth payer requirements can change rapidly—review payer bulletins and updates regularly.