DenQAIPatient-centered ownership

Payer, credentialing & cash continuity

Do not schedule, value, or finance revenue before the payable path exists.

An NPI, submitted profile, contract, directory listing, authorization, or seller deposit history answers only part of the question. Map the provider, entity, location, product, network path, effective date, claim setup, payment channel, and first reconciled deposit separately.

Start the local workbenchDownload the offline Excel workbookRead the payer guide

Before you enter numbers

Know the question, gather the records, and choose how deep to go.

Determine which payer relationships will actually apply to this provider, entity, location, and product—and how patient access and practice cash will be protected while each relationship changes.

First useful review
25 minutes for a first coded transition; 60–120 minutes with reviewed records
What you receive
A readable cash-and-continuity summary, eight-step critical path, open safety checks, and offline Excel workbook
1

Gather these first

  • Coded payer, administrator, product, network, provider, entity, and location map
  • Credentialing profile and attestation status
  • Executed agreement, amendments, fee source, network path, effective-date confirmation, and notice terms
  • Clearinghouse, claim-acceptance, EFT, ERA, remittance, deposit, and first-paid-claim evidence
  • Aggregate weekly allowed amount, collection history, patient-access assumptions, and reserve plan
2

Guided review

Start here if you are learning the decision or do not have every record yet.

  • Use Payer A, Provider 1, Entity 1, and Location 1—not actual names.
  • Enter aggregate weekly cash assumptions for up to three relationships.
  • Mark the eight readiness steps honestly and read the peak cash-timing gap.
3

Detailed review

Use this after the first result, or with advisers and stronger records.

  • Use the offline workbook for authorized fee-portability and contract review.
  • Compare four individual participation scenarios without ranking them.
  • Classify payment reversals, eligibility events, recoupments, refunds, and underpayments separately.
Your output order
  1. Read and print the plain-language result on this page.
  2. Download the Excel decision workbook when one is available.
  3. Save a DenQAI project file if you want to reopen your inputs.
  4. Use raw CSV only for advanced data work.

Local payer-continuity workbench · fictional example loaded

Map the relationship, prove the effective path, and fund the cash gap.

Keep identification, credentialing, contracting, network access, effective date, claim setup, deposit timing, and first paid claim as separate facts.

Local aggregate boundary

Use coded payers, providers, entities, products, and locations.

No patient information, names, identifiers, exact dates, credentials, contracts, fee schedules, EOBs, portal contents, or actual payer names belong here. The workbook is the offline place for authorized confidential review.

No blocked pattern detected

This automated screen is limited. You remain responsible for the file.

1 · Transition and owner mandate

Define the patient, identity, contract, data, and pause rules before modeling cash.

Patient-centered payer mandate

2 · Three coded payer relationships

A payer brand is not a complete relationship map.

Select one coded payer to edit. The model keeps administrator, product, network source, provider, entity, location, effective date, and payment path visible.

Coded relationship map

Aggregate cash-continuity assumptions

Expected weekly bank cash$16,560

Allowed amount × entered steady collection rate.

First standard bank weekWeek 12

Effective week plus entered service-to-bank timing.

Patient-access cash at risk$86,112

Capacity not modeled as delivered while pending; not a guaranteed permanent loss.

Interim bank cash$23,184

Expected cash actually modeled during the pending period.

Recoverable later$18,547

Separate future recovery assumption; not current cash.

Unresolved exposure$4,637

Pending-service expected cash without current or modeled later recovery.

Peak timing gap$158,976

Maximum cumulative difference from entered steady-state cash.

Credentialing path3 / 8

Written confirmation or documented not-applicable conclusion.

Eight readiness steps—never replace them with “credentialed”

NPI, taxonomy, license, and identifiers currentDocumented
Credentialing profile complete and attestedDocumented
Contract and network path documentedDocumented
Provider, entity, location, product, and effective date confirmedOpen
Directory listing verifiedOpen
Claim and clearinghouse configuration verifiedOpen
EFT and ERA activeOpen
First paid claim reconciled to bank cashOpen

3 · Plain-language cash and continuity summary

Delayed care, current cash, future recovery, unresolved exposure, and reserve need remain separate.

Peak combined cash-timing gap$192,830

Across the 26-week payer transition.

Practice reserve margin-$32,830

Reserve less modeled peak timing gap; household reserve remains separate.

Patient-access cash at risk$94,032

Care not modeled as delivered while pending; not automatically permanent loss.

Interim bank cash$35,196

Modeled cash received during pending periods.

Future recoverable cash$21,781

Modeled later recovery with separate timing and evidence.

Unresolved pending exposure$7,871

Expected cash with no current or modeled future recovery.

Coded relationshipNetwork pathEffectiveFirst bank cashCredentialingPeak gapEvidence
Payer ADirect participation contractWeek 9Week 123 / 8$158,976Open
Payer BLeased or shared network pathWeek 4Week 65 / 8$31,988Reviewed with limits
Payer CUnknown—investigateWeek 1Week 21 / 8$5,100Open

Calculation rule: steady weekly expected bank cash equals aggregate expected allowed amount × entered collection rate. The transition model separately reports care not delivered while pending, interim cash, written later-recovery assumptions, unresolved exposure, and the cumulative timing gap through week 26. It does not call every delay a permanent loss.

4 · Individual participation scenarios

Compare patient access, bank cash, administrative work, reserve, and notice without ranking the payer decision.

These are one practice’s scenarios. They are not instructions for competitors to exchange fees, coordinate termination, or negotiate together.

Remain participating$72,000 / month
Pursue an individual amendment$78,000 / month
Use an alternative documented network path$70,000 / month
Leave the network$61,000 / month

5 · Payment-event ledger

Do not call every negative item a recoupment—or every positive item collected cash.

Separate the service period, cash period, event type, amount, offset or refund mechanism, evidence, and next action.

Recorded event amount$7,300
Cash reduction recorded$2,400
Cash recovery recorded$0
Unresolved amount$4,900
Duplicate-payment reversal$2,400
Retroactive eligibility change$3,100
Audit or recoupment$0
Refund or credit$0
Possible underpayment$1,800

6 · Seven safety checks that cannot be averaged away

Clear identity, effective date, patient communication, notice, reserve, privacy, and independent decision-making separately.

Correct billing and rendering identitiesOpen
Provider, entity, location, product, and effective dateOpen
Patient network and estimate communicationOpen
Contract, network path, amendments, and noticeOpen
Practice transition reserveOpen
Privacy, credentials, and data handlingOpen
Independent participation decisionOpen
33open controls
  1. Payer A: the payer, product, network path, cash assumptions, and reviewer are not tied to a reviewed supporting document.
  2. Payer A · Provider, entity, location, product, and effective date confirmed: written confirmation or a documented not-applicable conclusion is still open.
  3. Payer A · Directory listing verified: written confirmation or a documented not-applicable conclusion is still open.
  4. Payer A · Claim and clearinghouse configuration verified: written confirmation or a documented not-applicable conclusion is still open.
  5. Payer A · EFT and ERA active: written confirmation or a documented not-applicable conclusion is still open.
  6. Payer A · First paid claim reconciled to bank cash: written confirmation or a documented not-applicable conclusion is still open.
  7. Payer A: retroactive recovery is modeled without reviewed written support; set it to zero until verified.
  8. Payer B · Claim and clearinghouse configuration verified: written confirmation or a documented not-applicable conclusion is still open.
  9. Payer B · EFT and ERA active: written confirmation or a documented not-applicable conclusion is still open.
  10. Payer B · First paid claim reconciled to bank cash: written confirmation or a documented not-applicable conclusion is still open.
  11. Payer C: the payer, product, network path, cash assumptions, and reviewer are not tied to a reviewed supporting document.
  12. Payer C: the direct, leased, or administrator-only network path remains unknown.
  13. Payer C · Credentialing profile complete and attested: written confirmation or a documented not-applicable conclusion is still open.
  14. Payer C · Contract and network path documented: written confirmation or a documented not-applicable conclusion is still open.
  15. Payer C · Provider, entity, location, product, and effective date confirmed: written confirmation or a documented not-applicable conclusion is still open.
  16. Payer C · Directory listing verified: written confirmation or a documented not-applicable conclusion is still open.
  17. Payer C · Claim and clearinghouse configuration verified: written confirmation or a documented not-applicable conclusion is still open.
  18. Payer C · EFT and ERA active: written confirmation or a documented not-applicable conclusion is still open.
  19. Payer C · First paid claim reconciled to bank cash: written confirmation or a documented not-applicable conclusion is still open.
  20. Remain participating: the participation scenario lacks a reviewed supporting document.
  21. Pursue an individual amendment: the participation scenario lacks a reviewed supporting document.
  22. Use an alternative documented network path: the participation scenario lacks a reviewed supporting document.
  23. Leave the network: the participation scenario lacks a reviewed supporting document.
  24. Retroactive eligibility change: the payment event lacks a reviewed record, separate service and cash periods, or a next action.
  25. Possible underpayment: the payment event lacks a reviewed record, separate service and cash periods, or a next action.
  26. Correct billing and rendering identities: the safety check remains open.
  27. Provider, entity, location, product, and effective date: the safety check remains open.
  28. Patient network and estimate communication: the safety check remains open.
  29. Contract, network path, amendments, and notice: the safety check remains open.
  30. Practice transition reserve: the safety check remains open.
  31. Privacy, credentials, and data handling: the safety check remains open.
  32. Independent participation decision: the safety check remains open.
  33. Practice reserve is below the modeled peak payer cash-timing gap.

7 · Readable output first

Print the Decision Summary, use the offline workbook, then save the local project.

The workbook has separate sheets for authorized confidential fee portability and contract work. The browser project remains coded and aggregate. Neither file is uploaded by this page.

Payer, credentialing, and cash-continuity workbook

Relationship map, eight-step critical path, 26-week cash model, fee portability, participation scenarios, payment events, safety checks, questions, definitions, and sources.

Download Excel workbook
Advanced data · not the recommended reading format

Formula-safe CSV is for an adviser or software process. It does not include the readable page layout.

Fictional transition loaded. Replace every payer code, timing assumption, amount, status, and record locator.

What the cash result means

A timing gap is not the same as permanent revenue loss.

Patient-access cash at risk

Entered steady-state cash associated with care not modeled as delivered while participation is pending. Patients may defer, choose another setting, or continue through another documented path.

Interim bank cash

Expected cash modeled as actually received during the pending period—not charges, production, or an uncollected balance.

Recoverable later

Only the remaining expected cash multiplied by a separately entered recovery assumption and recovery week. Use zero without reviewed written support.

Unresolved exposure

Expected cash tied to pending-period care that is neither modeled as received now nor supported as recoverable later.

Peak timing gap

The largest cumulative difference between entered steady-state bank cash and transition bank cash across 26 weeks.

Reserve margin

Practice payer-transition reserve minus the peak timing gap. The household reserve remains a separate safety control.