Credentialing & the PPO Black Box

Getting YOU credentialed with the practice's insurance plans takes 60–90 days, and 120+ for some payers. Most plans will accept your paperwork 30–60 days before your start date. Translation: start credentialing the day the LOI is signed. Wait until closing and you'll own a practice whose patients you can't bill as in-network for months.

Many older sellers are grandfathered into Delta Premier reimbursement rates that closed to new providers years ago. You will NOT inherit those rates — you'll be credentialed at lower PPO tiers. If the practice's revenue leans on Premier rates, model the haircut into your offer price. This single line item has blindsided more buyers than almost anything else.

Once you own: know your effective reimbursement per plan (fee schedule × utilization), rank plans by real dollars per hour of chair time, renegotiate or drop the bottom one or two, and build an in-house membership plan for uninsured patients so 'no insurance' stops meaning 'no visit.'