Credentialing and contracting: the foundation of reimbursement
Getting into the right networks — with contracts that pay properly — is where a new practice's revenue either works or stalls.
Credentialing and contracting are the basis of starting a clinic or healthcare facility. They lay the foundation for relationships with insurance companies and patients alike.
Why network access matters
Patients look for in-network providers, so network access expands your potential patient pool. The contract behind that access determines whether the additional volume is actually profitable.
Negotiate with data
Effective negotiation uses locality, patient volume and service mix. Without that context, low rates quietly erode the margin on every visit.
Keep contracts current
Track contract terms and expirations, keep provider data and CAQH profiles current, and complete revalidations on time. A lapsed credential can pause billing entirely.
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