Question 1 of 10
How would you describe your current credentialing status?
Select the option that best reflects where your practice stands today.
Fully credentialed with all target payers — we're optimized
10
Credentialed with major payers; a few still pending
7
In the middle of credentialing — several payers not yet approved
3
Just starting out or severely behind — credentialing is a major gap
0
Question 2 of 10
How current is your CAQH ProView profile?
CAQH is the backbone of most commercial payer credentialing.
Updated within the last 90 days — all attestations current
10
Over 6 months since last update — may be expired
2
We don't have a CAQH profile / not sure what this is
0
Question 3 of 10
How well does your payer mix align with your patient population?
Misaligned payer mix is one of the most common silent revenue killers.
Actively managed — we review payer mix quarterly and adjust strategy
10
Mostly aligned — reviewed annually but not optimized
6
We accept most payers but haven't analyzed the mix
2
We just take whoever comes — no payer strategy
0
Question 4 of 10
How are you handling claim denials and rejections?
Industry average denial rate is 5–10%. Best-in-class is under 2%.
Dedicated denial management team — we track root causes and fix upstream issues
10
We work denials but reactively — no root cause analysis
6
Denials pile up — we get to them when we can
2
We don't have a denial management process
0
Question 5 of 10
Do you have a credentialing timeline tracker for new providers?
Without tracking, delays go undetected until they become expensive.
Yes — we have a live dashboard with milestone alerts for every application
10
Spreadsheet-based tracking — works but gaps exist
6
We track informally via email threads and memory
2
No tracking — we follow up when we remember to
0
Question 6 of 10
How quickly does your billing team submit claims after service?
Days-to-submit directly impacts cash flow and write-off risk.
Same-day or next-day — claims go out before close of business
10
2–3 days — solid but room to tighten
7
4–7 days — falling behind best practice
3
More than a week — significant cash flow impact
0
Question 7 of 10
Have you negotiated your payer fee schedules in the last 2 years?
Most practices leave 5–15% on the table by not renegotiating.
Yes — we actively negotiate and have secured above-market rates
10
We've requested reviews but results were mixed
5
We accept whatever rates the payer offers
1
I didn't know this was possible
0
Question 8 of 10
How do you handle out-of-network situations?
OON strategy can dramatically change your effective reimbursement rate.
Deliberate OON strategy — we've calculated which payers are worth joining vs. billing OON
10
We try to be in-network everywhere but accept OON when needed
5
Mostly in-network — we avoid OON to keep things simple
2
We don't have a defined OON approach
0
Question 9 of 10
What's your process for re-credentialing existing providers?
Missed re-credentialing deadlines cause payment holds. It's more common than most practices admit.
Automated reminders 90+ days out — we never miss a deadline
10
Calendar reminders — someone manually tracks expiration dates
6
We mostly catch them — but we've missed a couple
2
Reactive — we re-credential when payers notify us (or when payments stop)
0
Question 10 of 10
Do you have a dedicated resource managing credentialing and enrollment?
Who owns this in your organization?
Dedicated credentialing specialist or team — it's their only job
10
Shared role — billing or admin also handles credentialing
6
The practice manager or physician does it — squeezed in around other duties
2
No dedicated resource — it's whoever has bandwidth at the moment
0
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