# Payer-transition patient communication checklist

Educational planning draft—not a patient notice, legal opinion, benefit determination, payment guarantee, or substitute for the actual contract, plan, law, and qualified review.

## Before communication

- Identify the exact provider, billing entity, practice location, product, and network path affected.
- Confirm what is documented, what is still pending, the stated effective period, and who owns the next payer action.
- Separate credentialing, contracting, payer enrollment, directory display, claim setup, and payment setup.
- Determine which patients or appointment categories may be affected without placing patient-identifiable information in DenQAI.
- Have qualified reviewers assess the actual agreement, notice duties, state law, estimate language, continuity obligations, and patient financial-policy implications.

## What the communication should make understandable

- The practice's current documented participation status—not an assumed or promised future status.
- Whether the patient's particular product and network path have been verified.
- Which questions the practice can answer and which questions the patient should confirm with the plan.
- That eligibility, preauthorization, or predetermination may not guarantee final payment.
- How estimates will be handled and updated.
- What options exist if the relationship is still pending or is changing.
- Whom the patient can contact at the practice and plan.

## Controls

- Do not promise payment, benefits, effective dates, or network status that are not supported.
- Do not imply that an NPI or directory listing proves participation.
- Do not bill under a seller, departing provider, or other identity as a workaround.
- Do not pressure a patient to continue care without a clear estimate and alternatives.
- Preserve the approved communication, review role, broad communication period, and correction history in the practice's governed system.

## Recheck

Recheck the communication whenever the provider, entity, location, product, network path, effective date, fee terms, directory status, claim configuration, or patient-facing facts change.