Which Insurance Payers Should Practices Enroll With First?

Medical Answer

When a new provider joins a practice, managers often asks: “Which insurance companies should we start with?”

The wrong answer is: “All of them.”

One of the biggest mistakes practices make during provider enrollment is trying to enroll with every payer at the same time. While it may seem logical to maximize participation opportunities, successful practices typically prioritize enrollment based on patient demographics, payer mix, reimbursement potential, and market demand.

Every payer requires time, resources, documentation, follow-up, and ongoing maintenance. Trying to enroll with every payer simultaneously can overwhelm credentialing teams and slow progress across the board. The better approach is to prioritize the payers that matter most to your practice and patients.

Practices should generally prioritize enrollment with the insurance payers that cover the largest percentage of their patient population. Before beginning enrollment, review your payer mix, patient demographics, referral sources, and market conditions. Focusing on high-volume payers first helps providers begin participating and generating revenue more quickly while reducing unnecessary administrative work.

Start With Your Patient Population

The most important factor in determining payer priorities is understanding your patients. Ask questions such as:

• Who are our patients?
• What insurance plans do they carry?
• What age groups do we serve?
• What services do we provide?
• What geographic area do we cover?

Understanding the patient population is one of the first and most important steps in the discovery process. Enrollment decisions should be based on the population being served rather than assumptions about which payers are important.

Review Your Payer Mix

One of the best places to start is with your payer mix report. This report shows:

• Medicare volume
• Medicaid volume
• Commercial insurance volume
• Managed care participation
• Self-pay percentages

Review payer mix data to determine where enrollment efforts should be focused. Practices should understand which payers represent the largest percentage of patient encounters before prioritizing enrollment activities.

If 40% of your patients have one commercial payer, that payer likely deserves more attention than a payer representing only 2% of your patient volume.

Medicare Is Often a Top Priority

For many physician practices, Medicare enrollment is among the first priorities. This is especially true for:

• Internal medicine
• Family medicine
• Cardiology
• Orthopedics
• Pulmonology
• Other specialties serving large Medicare populations

Without Medicare enrollment, practices may miss opportunities to serve a substantial portion of their patient base. However, priorities vary based on specialty and local demographics.

Medicaid May Be Critical in Some Markets

In certain communities, Medicaid participation may be equally important. Practices serving:

• Pediatrics
• Behavioral health
• Community health populations
• Underserved areas

may find Medicaid enrollment essential to their growth strategy.

Understanding local demographics helps determine whether Medicaid should be an immediate priority or a secondary consideration.

Commercial Payers Should Be Prioritized Strategically

Commercial enrollment decisions should be driven by data. Review:

• Existing patient volume
• Referral patterns
• Employer-sponsored plans
• Local market share
• Competitor participation

Understand organizational and community needs before determining payer priorities. The largest national payer may not necessarily be the most important payer in your local market.

Talk to Your Billing Team

One of the best sources of information about payer priorities is your billing department. Make sure to involve the billing and finance teams when evaluating payer participation and enrollment strategy. Billing teams often understand:

• Payer volumes
• Reimbursement trends
• Denial patterns
• Payment speed
• Contract performance

At your next billing meeting, ask: “If we could only enroll with five payers first, which five would have the greatest impact on patient access and revenue?” That discussion often reveals valuable strategic insights.

Their insights can help determine which enrollments will have the greatest financial impact.

Consider Provider Specialty

Different specialties may require different enrollment strategies. For example:

Family Medicine

May prioritize:

• Medicare
• Medicaid
• Major commercial plans

Behavioral Health

May prioritize:

• Medicaid managed care
• Behavioral health networks
• Commercial mental health plans

Specialty Practices

May prioritize:

• Specific referral-based plans
• Regional networks
• Specialty-focused payer arrangements

The provider’s specialty and services should influence enrollment priorities.

Avoid the “Enroll Everywhere” Mistake

A common enrollment mistake is assuming participation with every payer is automatically beneficial. More participation means:

• More applications
• More maintenance
• More recredentialing
• More administrative work

Practices should focus on payer relationships that support their strategic goals. Sometimes a targeted approach creates better results than a broad one.

Think Beyond Initial Enrollment

Enrollment is not a one-time event. Every payer relationship requires ongoing management, including:

• Recredentialing
• Profile updates
• Contract maintenance
• Data verification

Before adding another payer, consider whether your team has the resources to maintain the relationship long-term.

Real Practice Example

A growing multispecialty practice initially planned to enroll a new physician with more than 20 payers simultaneously.

After reviewing payer mix data, leadership discovered that five payers represented nearly 80% of patient volume. The practice prioritized those five plans first.

As a result, the physician began participating with the majority of patients much sooner, while additional enrollments were completed over time.  The strategy accelerated revenue generation and reduced administrative burden.

Should every provider be enrolled with every payer?

Not necessarily. Every payer relationship should support the practice’s broader objectives.

Don’t treat payer enrollment as a volume exercise. The goal is not to enroll with the most payers. The goal is to enroll with the right payers. Practices that align enrollment strategy with patient demand and business goals often achieve better financial results.

Create a payer priority matrix. Rank payers based on:

• Patient volume
• Revenue potential
• Strategic importance
• Ease of enrollment
• Administrative requirements

This helps you make objective enrollment decisions rather than relying on assumptions.

Strengthen Your Enrollment Strategy

Practical steps to prioritize payers:

✅ Review payer mix reports.

✅ Meet with billing leadership.

✅ Identify top patient insurance plans.

✅ Evaluate provider specialty needs.

✅ Create a payer priority matrix.

✅ Rank enrollment opportunities.

✅ Identify one enrollment process improvement.

The goal is not simply to complete enrollments. The goal is to enroll strategically and accelerate reimbursement.

Bottom Line

Practices should not automatically enroll with every insurance payer at the same time. Instead, enrollment priorities should be based on patient demographics, payer mix, provider specialty, and business goals. By focusing on the payers that serve the largest percentage of patients, physician practices can accelerate participation, improve reimbursement, and make better use of credentialing resources.

Key Takeaways

• Not every payer should be treated as an equal priority.
• Your patient population should drive enrollment decisions.
• Existing payer mix data can help identify enrollment priorities.
• Medicare and Medicaid may be critical depending on your specialty and market.
• Commercial payer priorities vary by location and patient demographics.
• Billing and finance teams should help determine payer strategy.
• Strategic enrollment planning can accelerate reimbursement.

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