Network Status

A provider's participation status with a specific insurance payer, indicating whether they are in-network (contracted) or out-of-network (non-contracted) for reimbursement purposes.

Network status refers to whether a payer's provider network is open (accepting new providers), closed (not accepting), or restricted (accepting in certain specialties or areas only). When a payer's network is closed, it means they have determined they have enough providers in a given specialty and geographic area to meet their members' needs. Your credentialing application will be accepted and processed, but you will be placed on a waitlist. Some providers wait months or even years to get into a closed network. Network status can vary by specialty, by region, and by product line. A payer might have an open network for psychiatrists in rural counties but a closed network for dermatologists in metropolitan areas. Their Medicare Advantage network might be open while their commercial network is closed. Knowing a payer's network status before you apply saves time and frustration. There is no point in rushing a credentialing application to a payer that has a closed network in your specialty and area. On the other hand, some networks that are listed as closed will still accept applications from providers in underserved areas or high-demand specialties. If a network is closed, ask about their waitlist process and expected timeline. Some payers review their network adequacy quarterly and open spots as members leave or as enrollment grows. Getting on the waitlist early means you will be first in line when the network opens. Some practices use delegated credentialing through an IPA or large medical group to get around closed network restrictions. The group already has a contract with the payer, and adding a new provider to an existing group contract is different from adding an entirely new provider to the network.