Executive summary
Credentialing failures create revenue leakage that appears later as denials, takebacks, and AR stagnation. This playbook outlines the controls that protect revenue continuity across providers and locations.
Where leakage happens
- Rendering before enrollment is complete
- Taxonomy, location, and payer file mismatches
- Revalidation and roster issues not tracked to completion
- Provider moves and location adds that are not reflected across payers
Controls that protect revenue
- A single source of truth for enrollment status by payer and location
- A go-live checklist that blocks scheduling when enrollment is incomplete
- Weekly reconciliation between scheduling, credentialing, and billing systems
- Standardized documentation for payer submissions and follow-up
Operational reporting
- Providers scheduled while pending enrollment
- Claims submitted with enrollment flags or missing identifiers
- Denials tied to enrollment issues, by payer and location
- Aging of enrollment requests and payer response times
How to scale without chaos
- Standardize taxonomy, location naming, and payer submission packets
- Create escalation paths when payers miss SLAs
- Train front-end teams on the few actions that prevent most leakage
Next step
Build a single view of enrollment status by payer, location, and provider. Use it to block scheduling for incomplete enrollments and to drive a weekly follow-up cadence with clear ownership.