Services
You cannot bill a payer you are not enrolled with
Credentialing is the least visible part of the revenue cycle and one of the most expensive to get wrong. A provider who starts seeing patients before enrolment completes generates claims that cannot be billed, and revalidation deadlines arrive without warning.
The cost of a credentialing delay is not the paperwork. It is the revenue that does not exist while a new provider sees patients under an application that has not been approved. Depending on the payer, that window can run for months, and the encounters inside it are frequently unbillable rather than merely delayed.
The failure modes are mundane and consistent: an application submitted with an inconsistency the payer will not query but will park, a CAQH attestation that lapsed, a revalidation notice sent to an address nobody checks, a group roster that was never updated after someone left. None of these are difficult problems. They are tracking problems, and they are what tracking systems exist for.
We handle initial credentialing and enrolment, keep CAQH profiles attested and current, monitor revalidation and expiry dates before they become urgent, and maintain the payer roster as providers join and leave. Contracting is the natural extension. Once you know which payers you are with and what you are being paid, the question of whether those terms are worth renegotiating becomes answerable.
Credentialing & Contracting
Services in this group
Sold individually or bundled. Most engagements combine two or three.
Provider Credentialing
Initial credentialing, CAQH maintenance and revalidation tracking, so enrolment never lapses unnoticed.
About Provider Credentialing
Payer Enrollment & Revalidation
Enrolment is not a one-time event. Participation has to be maintained: revalidation cycles come round, group rosters change as providers join and leave, locations get added, and each payer has its own process and its own notification habits, several of which amount to sending a letter to an address you last used three years ago. We manage enrolment and revalidation across commercial and government payers, keep participation records current, and track deadlines ahead of time rather than discovering them through a denial that says the provider is not active.
Payer Contracting
Enrolment gets you in the door on a payer's standard terms. Contracting is the separate conversation about whether those terms should be better. It is worth having only once billing has run long enough to show your real payer mix, your actual reimbursement by code, and where you sit relative to what the work costs you. Otherwise you are negotiating on impression. We review current reimbursement against your mix, identify which contracts are worth reopening and which are not, and support the discussion with the data behind it. This works best after billing has been running for a while, which is why it is usually a second-year conversation rather than a first-month one.
FAQ
Questions we get asked
How long does credentialing take?
It varies by payer and by state, and it is largely outside anyone's control once an application is complete and submitted. What is controllable is whether the application goes in complete and correct the first time, and whether it is followed up on a schedule rather than when someone remembers. Those two things are the difference between the normal range and the horror stories.
Can you take over credentialing for providers we already have enrolled?
Yes, and this is the common case. We audit the current state first, which payers each provider is enrolled with, which enrolments are active, what is approaching revalidation, and whether CAQH is current. That audit usually surfaces at least one thing nobody knew about, and it is the base for everything afterwards.
Do you handle contracting as well as enrolment?
Yes, as a separate service line. Enrolment gets you in the door with a payer on their standard terms. Contracting is the conversation about what those terms should be, which requires knowing your actual payer mix and reimbursement patterns. It is worth doing after billing has been running long enough to produce that picture.
Related
Complete solutions
End-to-End Revenue Cycle Management
Every service we offer, run as one engagement, from registration through to disputes.
About End-to-End Revenue Cycle ManagementER Billing Services
Emergency department revenue cycle: high volume, high out-of-network exposure, unpredictable payer mix.
About ER Billing ServicesUrgent Care & Clinic Billing
Walk-in volume, mixed payers and thin admin capacity, billing built for how urgent care actually runs.
About Urgent Care & Clinic Billing
Start with a free billing audit
We review a sample of your recent claims and your current A/R aging, and report where revenue is being lost. The report is yours whether or not you engage us.