Your Credentialing Matrix: How to Protect Your Practice from Denials and Disenrollment

Congratulations, you've done it! You've navigated the lengthy and detailed credentialing process, and you're officially an in-network provider. But if you're like many providers, you might be tempted to adopt a "set it and forget it" mentality now that the hard work is over. Unfortunately, this is one of the most common and costly pitfalls in revenue cycle management.

Successful billing doesn't end when you get a contract; it's an ongoing process that requires consistent, meticulous record-keeping to protect your practice's financial health. Think of it like maintaining a car after you've bought it—you can't just drive it off the lot and never look under the hood again. Neglecting this crucial "manage and review" stage can lead to unexpected denials, delayed payments, and even disenrollment from payer networks.

Why Ongoing Management Matters

Your credentialing status is not a one-time event; it's a continuous journey. Here are the key reasons why staying organized is just as important after contracting as it is during the credentialing process:

• Recredentialing and Re-attestation: Payers often require you to recredential or re-attest your information every two to three years, and sometimes annually. This is your chance to prove that you still meet their standards. Missing a re-attestation can be a "humongous risk," leading to your removal from the provider directory or even being ejected from the network.

• Keeping Information Updated: Failing to promptly update changes to your address, services, or provider licenses with payers can cause a "payment nightmare" and lead to denied claims. One provider learned this the hard way when they moved locations but forgot to notify the insurance company, causing claim denials because the checks were being sent to the old address.

• CAQH Account Management: Your CAQH account is a critical source for your credentialing data that payers use. You should schedule time to review your CAQH information every six to twelve months, even if you don't think anything has changed, as payers may use it to verify your data.

Your Go-To Tool: The Credentialing Matrix

For a growing practice, managing multiple providers and contracts can quickly become chaotic. This is where a Credentialing Matrix becomes a "game changer".

• Bird's-Eye View: This tool gives you a comprehensive view of every provider's credentialing status, for every finalized contract within your practice. You can record in-network payers, effective start dates, NPI and taxonomy details, and—most importantly—their re-attestation dates.

• Proactive Scheduling: The matrix allows you to proactively set reminders for upcoming re-attestations so no one "slips through the cracks". You can even use features like conditional formatting to visually flag upcoming dates, providing a "warning, warning, warning" signal on your spreadsheet.

• Resolve Denials Faster: A credentialing matrix helps you quickly identify and resolve denials related to provider information errors. By having all your data organized in one place, you can cross-reference the denial reason with your records and pinpoint the exact discrepancy that needs to be corrected.

• Avoiding Disenrollment Surprises: A lack of organized records can lead to major, time-consuming problems. One provider was completely wiped from the TRICARE system, a situation that could have been avoided with better organization and ongoing management. The Credentialing Matrix helps eliminate the guesswork and provides a clear record of how providers are credentialed within your practice.

Get Your Credentialing Matrix Today

Are you ready to stop stressing about billing and protect your practice's financial health? Don't let your "set it and forget it" mentality jeopardize the hard-earned in-network status you've worked so hard for. You can get a Credentialing Matrix template and other practical tools by subscribing to The Hourglass Learning Hub. Visit https://www.practicesol.com/pricing-plans to learn more.