Credentialing & enrollment
A new provider can't bill until they're enrolled. We get them enrolled.
Payer enrollment is unglamorous, slow, and one expired document away from a 60-day delay. We run the process start-to-finish — CAQH, PECOS, Medicaid, commercial — so your provider's first day at the practice is their first billable day.
Nothing wastes a new provider's time like enrollment that stalls. Start dates get pushed. Salary clocks tick while the provider can't bill. The practice eats the delta.
Credentialing is slow by design — CAQH re-attestations every 120 days, payer applications that move at their own pace, state Medicaid programs that can take six months. It's also easy to get wrong: one mismatched NPI, one gap in work history, one expired malpractice certificate, and the clock restarts.
Most practices handle this in-house because nobody else seems to want it. We want it. We've built the workflow around the fact that the work is tedious but the math is unforgiving.
Concretely, this is the work.
CAQH profile setup and maintenance — quarterly re-attestation on the calendar.
PECOS (Medicare) enrollment — typical 30–90 days for clean applications.
Commercial payer enrollments — 60–120 days depending on payer and state.
State Medicaid enrollments — 60–180 days, state-dependent, tracked weekly.
Re-credentialing cycles managed proactively, never reactively.
Primary source verification and document tracking.
New-provider onboarding — we start 120 days before their start date so they're billable on day one.
Credentialing reporting every month — where each application sits, what's blocking it.
Proactive, not reactive
Our average new-provider pipeline starts 120 days before their first day. That's how you avoid the "can't bill for three months" tax.
Document hygiene
Expired malpractice certificates, outdated work histories, NPI/PECOS mismatches — we catch these before the payer kicks the application back.
Credentialing as part of the MSO stack
When credentialing talks to billing talks to compliance, you don't lose revenue in the seams. Most vendors silo these — we don't.
No cliff. No rip-and-replace.
Week 1 · Audit
Full credentialing inventory — every provider, every payer, every expiration. We flag anything at risk of lapsing.
Weeks 2–6 · Rebuild
CAQH profiles refreshed. Missing documents gathered. Re-credentialing cycles put on an active calendar. New-provider pipelines opened.
Ongoing · Monthly discipline
Every month you get a report: each provider, each payer, status. Nothing expires unnoticed.
Real numbers, measured against your own baseline.
- Target runway before new-provider start date
- 120 days
- Lapses in covered providers (target)
- 0
- Reporting cadence
- Monthly
- Named lead per practice
- 1-to-1
Practices hiring new providers, practices that lost credentialing staff, multi-state groups, and any practice that's ever had a revenue hit because a re-credentialing lapsed. This pairs naturally with our RCM service — billing and credentialing working off the same source of truth.
Free audit
Curious where your practice is leaking money?
We'll audit your current workflow for free and show you exactly where to act — usually in under a week. No contract. You keep whatever we find.