> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Practice model: insurance-based

> The default practice model, in-network with payers. What the revenue machine looks like and where the operational weight sits.

An insurance-based practice contracts with payers and earns most revenue as
adjudicated claims. It's the default model because it's where the patients are, but it means running a serious back office from day one.

## The revenue machine

Every dollar flows through the pipeline described in
[How your practice gets paid](/start-here/02-how-your-practice-gets-paid) and
[The claim lifecycle](/concepts/claim-lifecycle): eligibility → visit → coding
→ claim → adjudication → [835/ERA](/concepts/what-is-an-835) → deposit →
[reconciliation](/concepts/reconciliation). The setup work is front-loaded:
[credentialing](/guides/get-credentialed) (90-150 days per payer, start before
you sign a lease), then [payer setup and EFT/ERA
enrollment](/guides/set-up-payers) for every plan you join.

## Choosing your panel

You don't have to take everything. Each payer contract is a fee schedule and a
compliance surface: model your expected volume by employer mix in your area,
start with the 4-6 payers that cover most of it, and add (or drop) payers
annually based on effective reimbursement per hour, collected dollars net of
denial and rework cost, not the rack-rate fee schedule.

## Where the money leaks

Denials ([CARC/RARC codes](/concepts/carc-rarc-denial-codes)), unworked aging,
underpayments against contract, and unposted paper EOBs
([lockboxes](/concepts/lockboxes) exist for a reason). The fix is structural:
enroll in ERA everywhere, reconcile deposits to remittances weekly, and track
denial rate by payer.

## Related

* [Get credentialed](/guides/get-credentialed)
* [The claim lifecycle](/concepts/claim-lifecycle)
* [Payer EFT/ERA enrollment directory](/reference/payer-enrollment-directory)
* [Practice model: cash-pay only](/concepts/practice-models-cash-pay)
* [Practice model: hybrid and membership](/concepts/practice-models-hybrid)