Payer enrollment
Credentialing and Enrollment, Tracked to the Effective Date
Payer enrollment, CAQH upkeep and re-credentialing tracked on a calendar, so nobody bills out of network by accident.
The short version
Credentialing & Enrollment without the guesswork
A provider who is not enrolled is a provider who cannot be paid. Yet credentialing is routinely treated as paperwork to be done once, when it is really a rolling calendar of applications, attestations, revalidations and contract effective dates that each carry a financial consequence if missed.
We manage that calendar. Applications are submitted with complete documentation the first time, CAQH profiles are re-attested before they lapse, and every provider has a visible status showing which payers are approved, pending or expiring within ninety days.
Why this matters
The credentialing failures that cost the most
Almost every credentialing loss traces back to a date nobody was watching or a form nobody completed fully.
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A lapsed CAQH attestation
CAQH requires re-attestation every 120 days. A lapse can suspend directory listings and stall pending applications.
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Billing before the effective date
Services delivered before a contract is effective are usually not retro-payable, and patients get charged out-of-network rates.
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Incomplete initial applications
A missing malpractice face sheet or an unexplained gap in work history sends an application back to the start of a 90-day queue.
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Missed revalidation
Medicare revalidation notices are easy to miss, and deactivation stops all payment until the record is reinstated.
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Group linkage never completed
An individually enrolled provider whose reassignment to the group was never filed generates claims that pay the wrong party, or nobody.
Scope of work
What we handle
Everything below is in scope from day one. Nothing here is an upsell later.
Medicare enrollment and PECOS
Initial 855I and 855R filings, reassignments, revalidations and group linkage managed through PECOS.
Medicaid enrollment
State-by-state Medicaid enrollment including the state-specific portals and supplemental forms each one requires.
CAQH profile management
Profile build, document upload and re-attestation on schedule so the profile never goes stale.
Commercial payer contracting
Applications, contract requests and fee schedule review with the commercial plans that matter to your patient mix.
Re-credentialing calendar
Licenses, DEA registrations, malpractice coverage and payer terms all tracked with escalating reminders.
NPI and taxonomy setup
Type 1 and Type 2 NPI registration and taxonomy selection that matches how you actually intend to bill.
Workflow
How an enrollment runs
The same sequence runs every day, which is what makes the output predictable.
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1
Document collection
We gather licenses, DEA, board certifications, malpractice, CV and identifiers into one verified provider file.
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2
Gap resolution
Work history gaps, name changes and address inconsistencies are resolved before anything is submitted.
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3
CAQH build or refresh
The CAQH profile is completed and attested so payers pulling from it see current, complete data.
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4
Application submission
Payer applications are filed with all supporting documents attached, tracked by submission reference.
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5
Active follow-up
We contact each payer on a fixed cadence rather than waiting. Most delays are resolvable if caught early.
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6
Contract and fee review
We confirm the effective date and review the offered fee schedule before it is countersigned.
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7
Go-live confirmation
Billing is only switched on for a payer once we have written confirmation of the effective date.
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8
Ongoing maintenance
Revalidations, attestations and expirables move onto the maintenance calendar with owners and reminders.
Questions
About Credentialing & Enrollment
What practices usually want to know before handing this part of the revenue cycle over.
Ask us something elseCommercial payers commonly run 60 to 120 days and Medicare typically 45 to 90. We cannot compress a payer queue, but complete first-time submissions and scheduled follow-up avoid the restarts that turn 90 days into 200.
Yes. New group setup involves Type 2 NPI registration, group enrollment and then reassignment of each individual provider. We sequence those correctly, which matters, because doing them out of order causes rejections.
We check for it on every approval. Where a retroactive date applies, we identify the affected encounters and submit those claims inside the filing window so the retro period is not wasted.
How it works
How working with us actually starts
No long implementation project, no switching systems. Four steps, and most practices are live inside a month.
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01
Revenue assessment
We audit a sample of your claims, denials and aged A/R and show you what we found. Free, and yours to keep either way.
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02
Scope and agreement
A written scope covering exactly which services we run, what it costs and what we are accountable for.
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03
Access and onboarding
We set up inside your existing EHR and clearinghouse. Two to four weeks, run in parallel with your current process.
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04
Live and reporting
We take over submission and follow-up, and you get monthly reporting you can actually act on.
Free consultation
Want a read on your credentialing and enrollment?
We will review a sample of your claims and come back with what we found. No cost, no commitment, and the findings are yours regardless of what you decide.