This is the one that costs money rather than time, and it catches people who did everything else right.
Two different questions
A license — or a privilege, once they exist — answers a regulatory question: are you permitted to practice in this state. Payer enrollment answers a commercial one: has this insurer agreed to pay you, under this tax ID, at this location, for this scope.
Nothing about the first produces the second. Being licensed in a state does not enrol you with its Medicaid program, and being in-network with a national plan in one state does not make you in-network with the same plan in another. Contracts are per-state and per-payer.
Why the timing bites
Enrollment frequently takes longer than the license did. A PA who sequences them — license first, then start enrollment — can be licensed, credentialed by the practice, seeing patients, and still not billable for months.
The work is done and the claims are not payable. Some payers will backdate an effective date; many will not, and the ones that will often cap how far.
What to do about it
Start enrollment in parallel with the license application rather than after it, accepting that some payers will not open a file until the license number exists. Know which of your payers will backdate before you plan a start date around them.
This is a different discipline from licensing, and our sister team handles it: whiteglovecredentialing.com.
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