BCP: Medicare, Medicaid & Private Payer Enrollment, Contracting, and Credentialing

Navigating the complex landscape of payer enrollment and credentialing is a foundational competency for any successful O&P practice. This elective provides participants with a practical overview of the enrollment and contracting processes for Medicare, Medicaid, and commercial payers, including key requirements, timelines, and common pitfalls to avoid. Learners will explore the credentialing process from initial application through ongoing maintenance, and gain insight into how payer contracts influence reimbursement rates, coverage policies, and compliance obligations. By the end of this course, participants will be better equipped to manage payer relationships strategically and ensure their practice remains properly enrolled, credentialed, and positioned for sustainable revenue.

Learning Objectives

1. Distinguish the enrollment and credentialing requirements across Medicare, Medicaid, and commercial payers, including key documentation, timelines, and common pitfalls, to ensure your O&P clinic remains properly enrolled and compliant.
2. Explain how payer contracts impact reimbursement rates, coverage policies, and compliance obligations, and identify strategies for reviewing and negotiating contract terms that support sustainable clinic revenue.
3. Develop a systematic approach to managing the credentialing lifecycle, from initial application through ongoing maintenance, to minimize disruptions in payer participation and protect the financial health of your clinic.

This is a Business Certificate Program elective under the Healthcare Management pillar. Note: At the end of this course, you will receive a certificate for CE credit upon successful completion of the quiz.  Please note that is a certificate for CE credits only and not the IIOP and AOPA O&P Business Certificate. The IIOP and AOPA O&P Business Certificate requires enrollment in and successful completion of four AOPA electives (one from each pillar) and four IIOP core courses. Upon successful completion of the Business Certificate Program, AOPA will reach out to you about receiving your O&P Business Certificate. 

Individuals not participating in the AOPA and IIOP Business Certificate Program are still welcome to take this course for CE credit and/or educational purposes. If you have not expressed interest in the Business Certificate Program and would like to participate and use this course as one of the required electives, please email onlineeducation@aopanet.org.