The Contract is Signed, Now What? What Your In-Network Start Date Really Means

You’ve done the work, you've survived the long, tedious process of credentialing, and you finally have a signed insurance contract in hand. You’re in! You can immediately start seeing patients and submitting claims, right?

Not so fast. This is one of the most common and frustrating misconceptions in the healthcare industry, and making this mistake can cost you a lot of time and money.

When a practice receives a contract from a payer, the first misconception is that they are now in-network. In reality, receiving a contract is just one step in the process. You must still review it, negotiate if desired, and then sign and return the contract. The contract outlines all the vital terms of your partnership, from payment timelines to audit clauses, so reviewing it carefully is a non-negotiable.

The second misconception is that once you sign the contract and send it back, you can immediately start submitting claims. While signing a contract is a huge win, it doesn't mean you're immediately in-network.

The Green Light to Play The Claim Game: Your In-Network Start Date

The signed contract is not your proof of in-network status. That proof, the actual green light to submit claims, is your in-network start date.

If you submit claims for services provided even one day before your official in-network start date, they will be denied. And unlike most claim denials, this is not an issue you can appeal—these are final determination denials. As a billing director once put it, "you assume no grace". There is no creative thinking or mercy on the other side. They just deny the claim.

This is the kind of mistake that can lead to you working for free, or your practice waiting 18 months or more to get paid for a batch of claims. It’s a time drain and a potential loss of revenue that most practice owners don't have the margin or bandwidth to handle.

The Best Practice: Patience is a Virtue

Your contract and start date won’t be delivered together. Some payers will send a welcome letter with a future start date after you’ve signed. Others may include an effective date in the contract, but it's typically 30 to 60 days in the future.

So what’s the move? The actionable takeaway is simple: wait for your official start date before seeing patients under a new credentialing approval. Patience truly is a virtue when it comes to navigating the insurance landscape.

Here’s how you can make sure your practice is ready:

• Track Everything: Use a tool like our credentialing application follow-up log to note the date you receive your contract, as well as the date you send it back.

• Document Your Start Date: When you receive your start date, add it to your insurance contract reference guide or credentialing matrix. This turns potential chaos into clarity by giving you a bird’s-eye view of your in-network status with every payer.

• Fight with Clarity: If you ever get an "unrecognized provider" or "NPI not registered" denial, your credentialing matrix gives you the fighting power you need to prove you've done your due diligence and were in-network on the date of service.

The resources mentioned are available for download with an Hourglass Learning Hub subscription. You can sign up at https://www.practicesol.com/pricing-plans/list.

By staying organized and waiting for that all-important start date, you’re not just avoiding a headache; you're legitimately getting your "player piece" on the board.

Want to learn more about the process of credentialing and all other things related to billing? Be sure to tune in to The Claim Game podcast, where we break down complex billing processes and share real-world solutions.