Service
A physician who is not credentialed with a payer cannot be paid by that payer, no matter how clean the claim is. Applications stall over a missing diploma copy, a CAQH attestation nobody re-signed, or a re-credentialing notice that landed in the wrong inbox. We run enrollment as a tracked process with deadlines owned by someone other than your office manager.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
We build the provider file first — licenses, DEA registration, controlled substance certification where applicable, diplomas, board certification or letter of acceptance, current CV, hospital affiliations, malpractice coverage, and banking details for EFT setup. Applications then go to each designated payer in that payer's required format. From there it is follow-up: contacting the payer on a schedule until a determination is issued, and answering requests for additional information quickly, because an application waiting on your response is an application not moving.
Payers pull from CAQH, and a profile that has lapsed attestation or an expired license on file will stall an application that is otherwise complete. We maintain your CAQH record, re-attest on schedule, and upload replacement documents before the ones on file expire. NPI registry entries are kept aligned with your actual practice locations, taxonomy, and group affiliations, since mismatches between NPPES and payer records generate claim rejections that look like billing errors but are not.
Re-credentialing cycles differ by payer and arrive without much warning. Miss one and the provider drops out of network — claims deny, patients get balance-billed by surprise, and reinstatement takes months. We track every provider's cycle date against every payer, start the renewal well ahead of the deadline, and monitor expirables on a rolling calendar: license renewals, DEA registration, board certification, and malpractice policy dates all get watched before they become an enrollment problem.
Practices change constantly. A physician joins the group, a provider moves to a new location, a tax ID changes, a new specialty line opens. Each one requires payer notification and often a fresh application, and each one produces denials when it is handled late. We manage adds, terminations, location changes, and group linkage, and support contracting work — reviewing fee schedule terms and requesting participation with payers where you currently have no agreement in place.
Process
We gather licenses, DEA registration, diplomas, board certification, CV, affiliations, malpractice coverage, and banking details, then verify each item is current and legible before anything is submitted.
Applications are prepared in the exact format each payer requires and filed with the correct supporting attachments, because incomplete submissions restart the clock rather than pausing it.
Every application is tracked and the payer contacted on a set cadence until an effective date is issued. Requests for additional information are answered promptly to avoid resets.
Effective dates, re-credentialing cycles, CAQH attestations, and document expirations go onto a rolling calendar, so renewals start early and no provider silently falls out of network.
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Certified coders assign accurate CPT, ICD-10, and HCPCS codes with NCCI edit checks, E&M leveling, and documentation queries that cut denials and audit risk.
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FAQ
Most commercial payers take roughly 90 to 120 days from a complete submission, and government payers vary. The timeline is controlled by the payer, not by effort. What we control is submitting a complete application the first time and following up consistently, since incomplete files and unanswered information requests are the main causes of avoidable delay.
It depends on the payer and the effective date they assign. Some backdate to the application date, some to the approval date, and some allow retroactive billing within a limited window. We tell you the rule for each payer up front so you can decide whether to hold claims, bill the patient, or schedule around the gap.
State medical licenses, DEA registration, state controlled substance certification where applicable, educational diplomas, board certificate or letter of acceptance, current CV, hospital affiliation letters, malpractice insurance certificates, banking information with a voided check, and anything a specific payer additionally requires. We send a checklist and chase the gaps.
Yes, and it is where most practices get hurt. We track each provider's cycle with each payer plus all expirable documents on a rolling calendar and begin renewals ahead of the deadline. A missed re-credentialing means network termination, denied claims, and a months-long reinstatement.
We support contracting work — requesting participation with payers you are not currently in network with, reviewing fee schedule terms, and managing the paperwork through execution. What we will not do is promise a specific rate outcome, because payer willingness depends on your market, specialty, and volume rather than on the request itself.
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
