Provider Enrollment and Contracting for Small Practices

Course Description

Navigating provider enrollment and payor contracting is one of the most critical operational challenges facing small practices today. Delays in credentialing, administrative errors, or accepting unfavorable contract terms directly jeopardize practice cash flow, disrupt patient access, and compromise overall financial viability. As healthcare regulations, commercial payor requirements, and CMS policies continue to evolve entering 2027, medical practices must adopt proactive strategies to streamline clinician onboarding, eliminate reimbursement bottlenecks, and protect bottom-line revenue.

This comprehensive training webinar provides practice leaders, credentialing specialists, billing managers, and administrators with a clear, practical roadmap to master provider enrollment and payor contracting in 2027. Participants will learn how to navigate primary credentialing portals like CAQH ProView and Medicare PECOS, manage ongoing revalidation cycles without interruption, and successfully overcome persistent operational obstacles such as closed payor panels.

Additionally, the course explores strategic decision-making around in-network versus out-of-network participation, evaluating diverse lines of business (including Commercial, Medicare Advantage, HMO, and PPO options), and maintaining compliant billing continuity while credentialing remains pending. Beyond initial onboarding, attendees will gain actionable tactics for holding payors accountable to statutory processing timelines, thoroughly auditing fee schedules, and negotiating equitable contract terms. Whether onboarding new providers or optimizing existing payor networks, this webinar equips your team with essential tools to safeguard revenue, avoid claims denials, and maintain operational compliance.

• Learn the key differences between provider credentialing and contracting.
• Decide whether it’s better to be in-network or out-of-network with specific plans.
• Choose the optimal lines of business when contracting (Commercial, MA, HMO, PPO, etc.).
• Utilize CAQH ProView effectively for initial setup, updates, and attestations.
• Identify practical action steps to take when facing a closed payor panel.
• Manage patient care and compliant billing during the pending credentialing process.
• Implement robust credentialing maintenance protocols to prevent unexpected terminations.

• Foundations of Enrollment vs. Credentialing vs. Contracting
• Defining primary source verification, network inclusion, and legal contract execution.
• Mapping out the complete timeline from provider hiring to first reimbursement.
• In-Network vs. Out-of-Network Participation Strategy
• Financial risk-benefit analysis of participating vs. non-participating provider status.
• Assessing local market trends, patient demographics, and out-of-network benefits.
• Selecting Lines of Business (LOB)
• Navigating Commercial, Medicare Advantage, Medicaid Managed Care, HMO, and PPO products.
• Structuring contracts based on small practice capacity and patient population goals.
• Mastering CAQH ProView Management
• Initial profile setup, document management, and error prevention strategies.
• Managing the mandatory 120-day attestation cycle to avoid auto-deactivation.
• Strategies for Overcoming Closed Payor Panels
• Crafting high-impact panel lock appeal letters to medical directors.
• Leveraging geographic gaps in care, sub-specialties, and extended clinic hours.
• Compliant Billing During Pending Enrollment
• Utilizing locum tenens, reciprocal billing, and incident-to billing rules legally.
• Managing patient communication and financial expectations during onboarding delays.
• Credentialing Maintenance & Revalidation Workflows
• Establishing internal tracking for license, DEA, malpractice, and board certifications.
• Managing CMS revalidation timelines to prevent Medicare billing stops.
• Navigating Commercial Payor Enrollment Portals
• Working with major commercial payors (Availity, Council for Affordable Quality Healthcare, etc.).
• Tracking application states across state-specific credentialing portals.
• Out-of-state provider enrollment nuances for cross-border telehealth services.
• Interactive Q&A session with Lisa Maciejewski-West

• Practice Managers (CPM, FACMPE)
• Practice Administrators
• Certified Provider Credentialing Specialists (CPCS)
• Certified Medical Services Managers (CMSM)
• Medical Billing Managers & Supervisors (CMRS, CPB)
• Revenue Cycle Managers & Directors (CRCR)
• Solo & Small Group Physician Owners (MD, DO)
• Advanced Practice Providers & Nurse Practitioners (NP-C, FNP-BC, APRN)
• Physician Assistants (PA-C)
• Clinic Operations Directors (CMPE)
• Medical Credentialing Coordinators & Analysts
• Medical Office Managers (AAPC Certified)
• Healthcare Compliance Officers (CHC, CCEP)
• Provider Relations & Contracting Specialists
• Healthcare Financial Managers (CHFP)
• Chiropractors & Allied Health Practice Owners (DC, DPT, OTR/L)
• Behavioral & Mental Health Practice Owners (LCSW, LMFT, PsyD)
• Enrollment & Revenue Integrity Specialists
• Healthcare Business Consultants
• Chief Executive Officers & Chief Medical Officers (CEO, CMO)

Lisa Maciejewski-West, CMC, CMOM, CMIS, CPCO-I has been involved in the medical billing, management, and consulting fields since 1982. Starting out as a front desk receptionist, she moved through the ranks to become a biller, medical assistant, and practice manager. In 1999, Lisa started working for a national practice management organization as a full-time practice coach and speaker. Over her 10-year tenure, she coached more than 190 providers and their staff to success and taught medical staff, billing, and office management courses an average of 20 times per year.

In 2006, Lisa founded Gold Star Medical Business Services to provide a part-time job for her then-disabled husband. Upon his death in 2009, Lisa took over running Gold Star full-time. The company currently serves over 150 practices, providing outsourced billing, compliance, credentialing, and practice management consulting services for medical providers and clinics nationwide.

Lisa is a Certified Medical Coder, Medical Insurance Specialist, Medical Office Manager, Medical Auditor, and Certified Professional Compliance Officer, as well as a CPCO Instructor with the American Academy of Professional Coders (AAPC). She has delivered billing, coding, compliance, and credentialing courses to more than 65 state, district, local, and private medical organizations and associations throughout the world.

In 2022 and 2023, Lisa and her team led several focus groups at the American Medical Billing Association’s (AMBA) national conference in Las Vegas. In 2025, Lisa was invited to serve as the Keynote Speaker for the AMBA National Conference. She also serves on the National Advisory Board of AMBA.

In September 2023, Lisa was appointed by Texas Governor Greg Abbott to serve on the Board of the Texas State Office of Risk Management (SORM), which oversees the Workers' Compensation Fund and other auto and property insurance plans for state employees, state-owned vehicles, and buildings. Lisa serves as Vice-Chair of the SORM Board.

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