Commercial payer enrollment
Application preparation and submission to every major national and regional carrier, with follow-up and escalation through to effective date.
03 · Credentialing
Credentialing & Payer Enrollment
A provider who cannot bill is an expensive passenger. We get clinicians enrolled, privileged and payable — and keep every attestation, licence and revalidation current.
Engagement at a glance
- Engagement modelPer-provider flat fee, or contingency for large group projects
- Ramp-upSame-week start once documents are collected
- IntakeWe chase the provider and the hospital, not your office manager
- TrackingLive status sheet per provider per payer, shared and time-stamped
- EscalationNamed escalation contact per payer when timelines slip
- RenewalsAutomatic revalidation and reappointment management included
60–90
Days to commercial enrollment
Typical range; we track and escalate every application daily.
100%
Expirables under management
Licences, DEA, malpractice, CAQH attestations and board certifications.
0
Lapsed revalidations
Twelve-month look-ahead calendar with escalation at 120 days.
The problem
Every payer, every provider, every deadline — in one place.
Credentialing is not hard, it is relentless. Every payer wants slightly different paperwork, every hospital has its own privileging committee calendar, and a single missed attestation can stop a provider from billing for weeks.
We run it as a managed process: a single source-of-truth profile per provider, applications filed the week a clinician signs, and a follow-up cadence that keeps every file moving instead of waiting in a payer's inbox.
For groups, we also manage roster accuracy — the quiet killer where a payer's directory has the wrong location, the wrong tax ID, or a terminated provider still listed and getting claims denied.
What's included
Everything in this service, in writing.
Medicare & Medicaid
PECOS enrollment, revalidation and reassignment; state Medicaid programs including managed-care plan enrolment.
Hospital privileging
Privilege applications, delineation of privileges, references, committee tracking and reappointment cycles.
CAQH ProView management
Profile build, attestation, document upload, and quarterly attestation reminders handled for the provider.
Expirables management
Licences, DEA, board certifications, malpractice, TB and OSHA records tracked with 120/90/60/30 day escalation.
Roster & directory accuracy
Payer directory audits so patients find you, claims route correctly, and terminated providers are removed on time.
How it runs
The engagement, step by step.
01
Provider intake
One structured request for every document, chased to completion by us — including the awkward ones from the medical school registrar.
02
Application build
We complete every form from the master profile, verify against source documents, and route to the provider for signature only.
03
Submission & follow-up
Filed with each payer, logged, and followed on a fixed cadence with escalation paths and reference numbers recorded.
04
Effective-date confirmation
We confirm the provider is loaded and payable in each system, test-claim if needed, then hand you a live billing matrix.
What we hold ourselves to
These are the operational targets we report against for this service. They are industry benchmarks and internal commitments — your results depend on your volume, payer mix and specialty, and we will tell you honestly where you should expect to land.
60–90 days
Commercial enrollment
30–60 days
Medicare enrollment
< 5 days
Application build time
100%
Expirables tracked
FAQ
Common questions.
Can you speed up a payer that is dragging?
Sometimes. We know which payers respond to provider-relations escalation, which respond to a state insurance department complaint, and which simply take 90 days. We will tell you honestly what is normal and escalate where it actually helps.
Do you handle new practices and new providers?
Both. New practices need a group-level setup — tax ID, group NPI, Medicare group enrolment, then each provider. New providers joining an enrolled group is usually faster because the group infrastructure exists.
How much of this does the provider have to do?
Signatures and a single intake call. We collect documents from hospitals, training programs and prior employers so the provider is not chasing paperwork between clinics.
What happens when a provider leaves?
Terminations matter as much as enrollments. We handle payer notifications, directory removal and reassignment so the group is not left billing under a departed provider's number.
Do you manage hospital privileges as well as payer enrollment?
Yes. Privileging has its own calendar — committee meetings, reappointment cycles, focused professional practice evaluation — and we manage it alongside payer enrollment so the two never contradict each other.
Related services
Often bought together.
Practice Auditing & Compliance
Pre- and post-payment chart audits, coding and billing reviews, HIPAA and OSHA assessments, and corrective action plans that hold up.
- Independent audit of coding, billing and documentation
- HIPAA, OSHA and program-integrity risk assessments
- Corrective action plans with measurable follow-up
Employee Management & Practice Staffing
Recruiting, onboarding, HR files, payroll and benefits administration, scheduling, policy handbooks and performance management for practice teams.
- Front desk, MA, billing and management recruiting
- Onboarding, HR compliance and payroll administration
- Handbooks, job descriptions and review cycles that hold up
Medical Supplies & Equipment Procurement
Group purchasing leverage, formulary and par-level management, cold-chain and DSCSA compliance, equipment sourcing and inventory control.
- Group purchasing contracts without changing your distributor
- Par levels, usage tracking and waste reduction
- Cold chain, expiry and DSCSA compliance built in
Talk to someone who has run this before.
Thirty minutes with an operations lead who works this service every day. Bring your numbers if you have them; we will tell you what we see either way.
A 30-minute call with an operations lead. No obligation, no sales sequence, and we will say so if you do not need us.