Credentialing & Enrollment
Payer enrollment, re-credentialing, CAQH maintenance, and Medicare/Medicaid applications — without the 90-day cash-flow black hole.
Why it matters
The hidden cost of getting this wrong
Credentialing is the most expensive thing most practices ignore. Every month a provider isn't credentialed with a payer is a month their visits aren't billable to that payer's patients — easily $20K–$50K per provider per month for a busy specialist. Re-credentialing lapses are even worse: claims get retro-denied. We track every payer, every expiration, every CAQH refresh date so nothing slips.
What's included
Everything in this service
Initial credentialing for Medicare, Medicaid, and commercial payers
CAQH ProView profile creation and quarterly refresh
Re-credentialing tracking with 120-day advance alerts
Texas Medicaid TMHP enrollment and revalidation
Medicare PECOS submissions and revalidations
Commercial payer applications (BCBS TX, Aetna, Cigna, UHC, Humana, Molina, Ambetter)
Hospital privileging support (initial appointment + reappointment)
DEA, state license, and malpractice tracking
Common pitfalls
What we see go wrong elsewhere
Patterns we run into when we audit incoming practices. If any of these sound familiar, your current setup may be leaving money on the table.
Letting CAQH attestations expire — payers immediately freeze claim payments
Submitting incomplete payer applications, triggering 30+ day rework cycles
Forgetting Medicare revalidation cycles (every 5 years; PECOS sends warnings 6 months out)
Not enrolling new providers in Medicare opt-out status before their first visit (if applicable)
Adding a new location without updating every payer — claims at the new location get denied
Performance benchmarks
What we hold ourselves to
Industry medians shown where applicable. We track these every week and report them to you, in writing.
60–90 days
Initial credentialing cycle (commercial)
100%
Re-credentialing on-time rate
0
CAQH attestation lapse rate
Frequently asked
What practices ask before they switch
How long does initial credentialing take?+
Commercial payers typically take 60–90 days from a complete application. Medicare can be faster (30–60 days). Medicaid is the wildcard — Texas Medicaid runs in the 60–120 day range. We start applications the day a provider signs an offer letter so they're credentialed by their start date, not 3 months after.
What if a provider is mid-credentialing when they join my practice?+
We pick up wherever they are. CAQH transfer is instant; payer-by-payer status takes a week to map. We then drive every open application to closure with weekly status updates.
Do you handle hospital privileging?+
Yes — initial appointments, reappointments, and any privilege-specific applications (e.g., ICU, telemetry). We coordinate with the hospital's medical staff office so providers don't have to.
Want to know what credentialing & enrollment is costing you?
Get a free Revenue Leakage Analysis — a one-page report with three specific revenue leaks at your practice and what they're costing per year. Delivered in 3 business days. No sales pitch.