Score the Panel Before You Sign: Which Networks Are Worth Joining

New practice owners tend to answer the panel question with a reflex: apply to everything, because an empty schedule is scarier than a bad contract. Then the schedule fills, and the shape of the mistake appears in the deposits — a caseload where some visits pay well below what they cost to deliver, locked in by contracts that renew quietly every year. The uncomfortable truth about panel selection is that it is a pricing decision you make before you have any revenue data, and it is far easier to decline a panel now than to leave one after a third of your families carry that card.

The fix is not a secret list of good and bad payers — the same national plan can be a strong panel in one city and a weak one two counties over. The fix is scoring each candidate network on the four factors that actually determine what a contract is worth to your practice: how many of your likely patients it covers, what it allows for the codes you actually bill, how much authorization work it demands per episode, and how fast and cleanly it pays. Every one of those answers is discoverable before you sign. This article shows you where each number lives, how to put the four together into a decision, and what to do about the panels you do not fully get to choose.

Score each candidate panel from 1 to 3 on every row below, using evidence rather than reputation, and total it. The exact weights matter less than the discipline: a panel has to earn its spot on measured demand and economics, not on the vague sense that “everyone takes” it. A panel that scores low on rate can still deserve a place if it dominates local volume — but then you are choosing it with open eyes, at a capped share of your caseload, instead of discovering the rate problem in next year’s bookkeeping.

The scorecard only works if you refuse to fill it with guesses. Each factor has a concrete place the answer lives, and collecting all of them is a few focused hours per panel — a small price against a contract that will govern hundreds of visits. Work through the panels in one push, the same way you would run any procurement.

1. 01

   Build the candidate list from real demand, not from the payer’s size

   Pull the last few months of inquiry calls and referrals and tally which plans families actually named. Ask your referring providers which plans their patients carry, and note the dominant employers and school systems in your area and who administers their benefits. The panels worth scoring are the ones that appear on this list — a national brand with no local members is just paperwork.

2. 02

   Identify your top codes and your cost per visit

   List the handful of CPT codes that make up the bulk of what you bill — evaluation and treatment codes for your discipline — and compute your all-in cost to deliver a visit: clinician time including documentation, rent, software, billing labor, and overhead, divided over realistic weekly visit volume. Without this number, no fee schedule can tell you anything, because “good rate” only means “above your cost with margin.”

3. 03

   Request the fee schedule for those codes, in writing

   Ask each payer’s provider relations or contracting contact for the allowed amounts on your specific codes before you sign, and keep the answer in writing. Payers routinely provide rates for the codes relevant to your specialty during contracting — and a payer that will not put numbers behind its own contract has told you something worth scoring. Never accept “competitive rates” as an answer.

4. 04

   Benchmark each offer against Medicare and against your cost

   Look up the same codes in the Medicare Physician Fee Schedule search tool for your locality and express each payer’s allowed amounts as a percentage of Medicare. Then check each against your cost per visit. The first comparison ranks the payers against each other; the second tells you whether the bottom of the ranking is merely less profitable or actually underwater.

5. 05

   Interview provider relations about the authorization workflow

   Ask scripted questions and write down the answers: Does evaluation require prior authorization? How many treatment visits does an initial approval cover, and for what date span? What triggers reauthorization, what documentation does it require, and what is the current turnaround? Multiply that burden by a year of typical episodes to see the real administrative cost of the panel.

6. 06

   Ask the people who already bill this payer how it actually behaves

   Fee schedules and policies are the brochure; remittances are the reality. Ask local colleagues in your discipline, your biller, or your billing service how fast this payer pays clean claims, what it denies, and whether it reprocesses cleanly. Your state insurance department publishes the prompt-pay rules that set the legal deadline — useful as the yardstick those anecdotes are measured against.

7. 07

   Score, rank, and decide — including the deliberate “no”s

   Fill in the scorecard, total the rows, and join from the top until your expected demand is covered. For every panel you decline, note why in one line and calendar a date to revisit — rates, panels, and your own cost structure all move. A written “no, because” today is what prevents the accidental “yes to everything” from reasserting itself when the schedule has a slow month.

The scorecard assumes you can freely decline, which is only fully true of commercial panels. Medicare is a different kind of decision, because therapists do not get the escape hatch physicians have: speech-language pathologists, occupational therapists, and physical therapists are not among the practitioner types permitted to opt out of Medicare and contract privately with beneficiaries. In practice that makes Medicare binary — enroll, or do not treat Medicare beneficiaries for covered services — and it is a decision to make before the first Medicare-eligible referral calls, not after. The upside is transparency: Medicare’s rates are public, so this is the one panel where the scorecard’s rate row requires no negotiation to fill in.

Medicaid is the other special case, and it resists generalization because it is run state by state — often through multiple managed-care organizations, each of which is effectively its own panel with its own rates, authorization rules, and payment behavior. For pediatric practices especially, Medicaid can represent a large share of real local demand, which argues for scoring each Medicaid MCO individually rather than accepting or dismissing “Medicaid” as a single thing. Get the actual fee schedules and authorization rules from your state agency and each MCO, and let those numbers — not folklore about Medicaid rates — fill in the rows.

Payment speed feels like the factor you can only learn the hard way, but it has more public structure than most owners realize. States set prompt-pay rules requiring insurers to pay, deny, or settle clean claims within a defined window, commonly with interest owed on late payments. The specifics genuinely vary by state — Oklahoma, for one example, requires clean claims to be reimbursed within 30 calendar days for electronic submissions and 45 for paper — and self-funded employer plans are generally outside these state rules entirely, so check your own state insurance department rather than assuming any number. The scorecard use is simple: your state’s deadline is the yardstick. A payer that local billers describe as routinely brushing against the statutory limit has earned its 1 before you ever submit a claim.

Claim friction is the half of this factor that no statute covers: how often a payer denies clean work, how much rework a denial costs, and how cleanly corrected claims reprocess. Two panels with identical fee schedules can differ meaningfully in what a visit nets once you account for the share of claims that take two or three touches to pay. That intelligence lives with the people already billing the payer — which is why the colleague interview in the process above is a scored input, not networking.

Sometimes the panel that wins your scorecard is not accepting new providers. A closed panel is a “not now,” not a “never” — networks reopen as members complain about wait times, providers retire, and the payer’s own adequacy picture shifts. Respond like an applicant with a case to make: ask provider relations, in writing, what would support an exception, and spell out the network gap you fill — your specialty and subspecialty skills, languages spoken, evening or weekend availability, geography the current panel covers thinly, and the waitlist evidence from your own phone log of this payer’s members seeking care they cannot schedule. Then calendar a polite re-inquiry on a regular cadence; closed panels are won by the practice that is easy to say yes to on the day something opens.

While you wait, those families are not unreachable. Members with out-of-network benefits can see you using a superbill, and some will — which, usefully, also builds exactly the documented demand that supports your next panel inquiry. What matters is that the decision stays yours and deliberate: serving a closed panel’s members out of network at your full rate is a strategy; drifting into a discounted handshake arrangement because the panel might open someday is not.

A year in, you hold something no payer brochure can argue with: your own data. Re-run the scorecard annually — a natural fit alongside your annual financial review — with the estimate columns replaced by actuals from your billing system: the effective rate each panel really paid per visit after denials and adjustments, the true days from submission to payment, the authorization hours each panel consumed, and the share of new patients each panel actually delivered. Panels migrate on real numbers: the generous fee schedule eroded by rework, the mediocre one redeemed by zero-friction payment.

A panel whose refreshed score has sunk earns one of two conversations, in order. First renegotiation — your utilization data and the gap between this payer and the rest of your panel mix are exactly the leverage a rate request is built on. Then, if the numbers will not move, a planned exit: on the contract’s notice terms, with continuity-of-care obligations met and affected families informed early. Leaving a panel is a normal portfolio decision, and it goes best for the practice that wrote down, back when it joined, exactly what the panel had to keep delivering to keep its spot.