How to Transition Provider Credentialing When Leaving or Joining an ACO
How to Transition Provider Credentialing When Leaving or Joining an ACO
Understanding ACO Credentialing and Payer Enrollment
When a provider participates in an Accountable Care Organization (ACO) or large group entity, their payer contracts and credentialing are tied to that organization’s Tax ID and Group NPI — not just their individual NPI.
Even if a provider remains individually credentialed through a future date (for example, through 2027), that credentialing is specific to the ACO’s enrollment and not automatically transferable to a new practice or organization.
Most ACOs will not allow dual credentialing, meaning a provider typically cannot remain credentialed under both an ACO and another entity for the same payer. This creates important steps when transitioning to a new group or independent practice.
Learn more about avoiding similar issues in our related article: Financial Operational Impact of Credentialing Errors
What Happens When a Provider Leaves an ACO
If a provider leaves an ACO or joins another organization, the payer participation agreements tied to the ACO’s Tax ID are typically terminated.
To continue seeing insured patients under a new entity, the provider must complete new credentialing and payer contracting under the new organization.
The transition process usually includes:
- Termination from the ACO
The provider or new group must notify the ACO and initiate termination. Once processed, payers remove the provider from the ACO’s active roster. - Primary Source Verification and Application Setup
The new organization (or TriumpHealth, on your behalf) submits the credentialing applications to necessary payers, so the primary source verification (license checks, DEA verification, and board certifications) can be completed. - New Contract and Linking Under Your Tax ID
A new credentialing and contracting process for the provider must be completed with each payer under your organization’s Tax ID and Type 2 NPI.
Once approved, the provider can be linked to your group contract, ensuring future claims process correctly.
Case Example: Transition from ACO to Private Group
A provider we recently assisted was credentialed as a Primary Care Provider under an ACO. According to AmeriHealth Caritas DE, her contracts were through the ACO, so she needed new contracts under her new organization, even though her credentialing record showed she was active through 2027.
Because her credentialing was tied to the ACO’s structure, it could not be transferred.
TriumpHealth helped coordinate the transition by:
- Submitting new credentialing applications to all payers
- Managing payer linking and effective date tracking
This ensured a smooth transition without interruption to patient care or reimbursement.
Why These Transitions Are Often Overlooked
Many providers assume that if they’re “credentialed,” they can bill under any organization, but credentialing is always tied to the Tax ID that holds the payer contract.
If the provider changes employers, practice settings, or ACO affiliations without updating enrollment, it can lead to:
- Denied or delayed claims
- Loss of network participation status
- Compliance or audit issues with payers and CMS
How TriumpHealth Can Help
TriumpHealth specializes in provider credentialing transitions for physicians, specialist providers, and group practices leaving or joining ACOs.
Our team ensures all providers are correctly linked, verified, and contracted under the right entity to prevent costly payment interruptions.
We assist with:
- Submitting new credentialing and contracting applications
- Updating CAQH profiles
- Linking providers under the correct Tax ID and Group NPI
- Avoiding network and reimbursement disruptions
Ready to Simplify Your Credentialing Transition?
If your organization is planning to leave an ACO, merge with another group, or onboard providers previously credentialed under a different entity, TriumpHealth can guide you every step of the way.
Contact TriumpHealth today to schedule a consultation with our credentialing experts and ensure your transition is handled accurately and efficiently. For more details contact us via email [email protected] or call us at (888) 747-3836 x0.