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Services

Credentialing & payer enrollment

Credentialing is administrative until the day it is not. A lapsed revalidation does not reduce your revenue. It stops it, for that provider, with that payer, retroactively.

Where it goes wrong

Credentialing fails on dates. A revalidation notice goes to an inbox nobody monitors. A CAQH attestation lapses because the reminder arrived during a busy week. A new provider starts seeing patients before their effective date, and ninety days of their claims are denied as out-of-network, often past appeal by the time anyone connects the dots.

None of that is complicated work. It is tracking work, and it fails for exactly that reason: it is nobody's actual job until it has already broken.

Credentialing timeline from application to effective date, commonly 60 to 120 days, with claims before the effective date denied as out of network. ApplicationPayer reviewCommitteeEffective dateday 060–120 days laterBillablefrom hereClaims submitted in this window are denied as out-of-network
The schedule belongs to the payer. What you control is submitting complete applications and knowing the effective date before scheduling.

What we do

  • Initial enrollment with commercial payers, Medicare and Medicaid, including PECOS, group and individual applications, and linking providers to the correct group TIN and locations.
  • CAQH ProView maintenance and re-attestation on schedule, with documents refreshed before they expire rather than after a payer rejects them.
  • Revalidation tracking with calendar alerts well ahead of each deadline, per provider and per payer.
  • Roster maintenance covering adds, terminations, location changes and name changes pushed to every payer, because a stale address on one payer’s roster quietly misdirects payments.
  • Document custody for licences, DEA registrations, board certifications and malpractice coverage, with expiry dates tracked centrally.
  • Effective-date discipline. You get told when a provider can actually bill a payer, so scheduling is not writing off claims that never had a chance.

The honest timeline

Payer credentialing is slow and mostly outside anyone's control. Commercial enrollments commonly run 60 to 120 days, and Medicare and Medicaid vary considerably by state and by backlog. Any vendor promising a fixed turnaround is promising something the payer has not agreed to. What we can do is submit complete applications first time, chase them on a schedule, and tell you honestly where each one stands.

Common questions

How long does credentialing take?

Commercial payers commonly take 60 to 120 days, and Medicare and Medicaid vary by state. The schedule belongs to the payer. What changes the outcome is submitting complete applications and following up persistently.

Can a new provider see patients while enrolment is pending?

Sometimes, under locum or supervising-provider arrangements, and some payers permit retroactive effective dates. The rules are payer-specific and getting this wrong creates unbillable visits, so confirm it per payer before scheduling.

Do you handle hospital privileging as well?

Our scope is payer enrollment and credentialing. Hospital medical-staff privileging is a separate process run by each facility, though much of the same documentation feeds both.

Start with the free audit

Send us ninety days of claims data and we will show you what was left uncollected. No charge, no obligation, and the findings are yours either way.

Request my free audit