Credentialing Compliance Failures Leading to Payment Denials

$10,000-$25,000 per incident (Medicare claim rework + patient dispute + customer service overhead) • $10,000-$30,000 monthly in Tricare denials + staff rework on manual verification • $10,000-$30,000 per denial; military patient cohort revenue blocked

Calendar reminders set by individual coordinators; manual database queries of CMS; phone calls to provider to confirm status; paper files marked with highlighter • Coordinator manually monitors Tricare website; prints requirement documents; maintains handwritten notes; relies on provider's knowledge of Tricare rules; periodic manual verification cycles • Coordinator manually tracks WC payer requirements via printed PDFs; notes on sticky notes; relies on provider self-reporting of credential status; periodic re-verification done on ad-hoc basis