30d • General discussion
Nobody tells you that getting on an MCO panel is not the hard part. Staying active is.
Everyone focuses on the credentialing application. The paperwork, the enrollment, the waiting, the approval.
And yes, that process is real and it matters and I have helped a lot of agencies get through it.
But here is what nobody tells you about what happens after you get approved:
MCOs re-credential you. Every two to three years, depending on the plan. And if you miss their recredentialing request — which often comes in as one letter to an address that may have changed, or an email that got buried — your contract gets terminated.
Quietly. Without a phone call. You find out when a claim gets denied.
Beyond recredentialing, MCOs also monitor your compliance status. Complaints filed against your agency. Survey deficiencies with the state. Licensing actions. Any of these can trigger a contract review or termination.
And then there is utilization. MCOs track whether you are actually serving members. If you are approved but dormant — no claims, no active clients under that plan — some plans will pull your contract to free up their network capacity.
Staying on a panel requires the same intentionality as getting on one:
Keep your contact information updated with every MCO you contract with. Calendar your recredentialing dates two months in advance. Submit claims consistently once you are approved. Keep your compliance record clean.
The agencies that build sustainable businesses treat their MCO relationships like business partnerships — not checkboxes they completed once and forgot about.
Do you know your recredentialing dates for each MCO you are contracted with? Drop a yes or no below.
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Nobody tells you that getting on an MCO panel is not the hard part. Staying active is.
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