Patient Friction and Churn When Providers Are Not In-Network Due to Credentialing Delays

$10,000–$40,000 per month per affected provider or site in written-off balances from surprise out-of-network bills, lost follow-up and downstream referrals when patients churn to in-network competitors, plus staff rework time and reputational damage that depresses future visit volume. • $12,000–$30,000/month in claim denials, rework labor, aged A/R carrying costs, and bad debt; secondary loss from patient anger over 'surprise bills' when they thought provider was in-network • $2,000–$10,000 per month in under-collection, waived balances, and no-shows from uninsured patients who lose confidence in pricing and seek free or lower-cost alternatives elsewhere.

Billing and coding specialists maintain unofficial lists of which employer-sponsored plans each provider is 'safe' to see, using Excel and email from the contracting/credentialing teams. They manually flag high-risk plans, hold or split claims, adjust modifiers and billing provider IDs, and frequently rebill after receiving out-of-network denials or patient complaints. • Billing and coding specialists manually track which providers are 'technically hired but not yet in-network' using internal spreadsheets and email threads, then try to catch and reroute these encounters in the billing workflow by overriding claim settings, holding claims, or reclassifying visits after denials and patient complaints. • Compliance and billing teams manually check workers’ comp network participation lists and TPA portals, keep separate spreadsheets of which providers are approved for which employers/TPAs, and have front office call adjusters for case-by-case authorization when network status is unclear.