Intro
Credentialing isn’t operational formality — it is financial permission.
Without optimized payer contracts:
- visits get underpaid
- payouts get delayed
- coverage gaps appear silently
1. Credentialing Determines Whether You Get Paid at All
No enrollment → no billing → no reimbursement.
Even minor errors cause:
- back-bill shutdowns
- claim freeze
- tax ID mismatches
2. Payer Contracts Are Negotiable
Low-fee credentialing firms submit.
We negotiate:
- reimbursement tables
- specialty carve-outs
- frequency compensation
- multi-location coverage
3. When Credentialing Is Done Poorly
You see:
- silent denials
- “non-covered service” flags
- credentialing lag vs start date gaps
- retroactive billing problems
4. What Proper Credentialing Unlocks
- full specialty reimbursement
- back-dated payouts
- provider expansion without claims loss
- accurate rate alignment