Provider Credentialing and Payer Enrollment
Getting your new provider on the panels, so they can see patients you can actually bill for.
Why credentialing stalls
Credentialing rarely fails. It stalls, which is worse, because nothing tells you it has happened.
An application goes in missing a date on a work history gap. The payer sets it aside. Nobody at the payer calls. Three months later somebody at your practice asks why the new provider is still not on the panel, and the answer is that the clock never started.
Meanwhile that provider is seeing patients you cannot bill for, or not seeing them at all.
The work is unglamorous and it is mostly follow-up. Applications get filed complete the first time, CAQH stays current, and somebody calls the payer every couple of weeks until there is a decision. That is the whole job, and it is exactly the job that gets dropped when the person doing it also has a day job.
What we handle
Initial enrollment for new providers, re-credentialing before it lapses, adding providers to existing group contracts, and new locations or tax IDs.
We maintain CAQH, keep licenses and DEA registrations tracked against their expiry dates, and file revalidations before the deadline rather than after the termination notice.
You get a status view showing every application, which payer has it, how long they have had it, and when we last chased them.
Common questions
How long will it take?
Ninety to a hundred and fifty days is typical for commercial payers once a complete application is in. Medicare and Medicaid vary by state. We will give you a realistic date on the first call, and it will not be the optimistic one.
Can you fix an application that is already stuck?
Usually. Send us what was filed and we will find out where it actually sits, which is often not where the practice thinks. Sometimes the answer is that it needs refiling, and it is better to know that now than in another two months.
What happens if a provider's credentialing lapses?
Claims deny and, depending on the payer and contract, you may have to refund what was already paid for the lapsed period. Re-credentialing dates are tracked from the day we take an account on, which is the cheapest problem to prevent.
See what your claims are leaving behind
Send us a month of remittance data and we will tell you what it says: which codes are being denied, how much of it is recoverable, and how long your money is sitting in A/R. It takes about a week and there is nothing to sign.