Credentialing Bottom Line, Episode 1 Recap
When Dan Bocian took over as Director of Therapy Services at Fox Valley Orthopedics, a private-practice orthopedic group in the suburbs of Chicago, he inherited a credentialing operation he couldn’t see into. The practice had been relying on a third-party management company to handle credentialing for its 55+ physical and occupational therapy clinicians. Dan’s mandate was to bring those services in-house. What he found when he looked under the hood surprised him.
The Problem Nobody Knew They Had
Credentialing gaps don’t announce themselves. They show up quietly, buried in denial reports, missed authorizations, and revenue that never materializes.
When Dan and his team began the transition, they discovered a patchwork of coverage issues: clinicians credentialed with some payers but not others, credentialed at one clinic location but not across locations, and, in one specific case, a credentialed location that the practice no longer even operated. None of this was visible until someone looked closely.
“I had really no insight into what our credentialing looked like,” Dan shared during the webinar. The gaps were costing the organization in ways that were hard to quantify, because nobody knew to measure what wasn’t happening.
The Story That Says It All
One clinician at Fox Valley had been educated outside the US and held a valid Illinois license. The previous credentialing services partner had been working to credential this provider with two specific payers for approximately three years, without success.
The H3 team took on the challenge. Three months later, the clinician’s credentials were secured.
That single resolution opened up an entire service line at that location, driving new revenue and eliminating the need to redirect patients. Three years of stalled progress, resolved quickly and completely.
When Credentialing Gaps Become Denial Generators
The most immediate financial impact Dan’s team uncovered was in prior authorizations. Authorization requests were being submitted and denied for clinicians who, it turns out, weren’t in-network at the clinic where they were treating.
For a 10-location therapy operation, those mismatches add up quickly. Every delayed treatment and or denied claim tied to a credentialing gap represents real revenue lost, real administrative time lost on rework, and friction for amazing clinicians who just want to treat patients in need.
What the Transition Actually Looked Like
One of the biggest barriers to changing credentialing partners is the fear of transition friction. Dan was candid about this: he expected it to be easy, but the scope of credentialing gaps made it more complex than he and his team anticipated. But the actual burden on his clinical staff was minimal.
Each clinician completed a brief online registration (roughly 3 to 5 minutes) that gave H3 the information needed to begin their research, identify gaps, and quickly start resolving issues. The H3 team handled the communication cadence (weekly at first, then biweekly), answered clinician questions directly, and absorbed the complexity so Dan and his team could focus on patient care.
“It took the burden off of our work and our clinicians to allow them and myself to do what we wanted to do, which was treat patients and get them better,” Dan said.
The Takeaway for Practice Leaders
Three lessons from Fox Valley’s experience worth considering:
You probably have credentialing gaps you can’t see. If your organization has experienced turnover, growth, location changes, or management transitions, there are likely providers who aren’t fully credentialed where they need to be. Those gaps translate directly to lost revenue, friction-filled PAs, and preventable denials.
Speed is the difference between revenue and revenue loss. The longer a credentialing issue sits unresolved, the longer a provider is generating claims that won’t get paid or not seeing patients they could be treating. The financial math on credentialing speed is simple: an uncredentialed provider can cost a practice thousands of dollars per day in lost collections.
The right partner absorbs complexity, never excuses. Dan’s team required more work to fill credentialing gaps than expected. H3 didn’t hesitate; didn’t renegotiate scope. They said “we’re going to make this right.” And they executed. That’s the difference between a vendor and a partner.
The Credentialing Bottom Line is a live education series from H3 Healthcare focused on the financial impact of credentialing and payer enrollment. If anything Dan shared sounds familiar, or if you’re sitting on a credentialing issue that’s been unresolved for too long, we’d love to talk.
Reach out at sales@h3althcare.com.