Provider Credentialing
Get on panels — and stay on them.
Payer enrollment and credentialing for clinicians and groups: CAQH, Medicare, Medicaid, and commercial panels managed through approval and revalidation.
Schedule Discovery CallWhat's included
- CAQH build-out and attestation upkeep
- Medicare, Medicaid, and commercial applications
- Group roster, NPI, and re-credentialing calendar
- Contract and fee-schedule review
Built for
- Solo clinicians joining commercial panels
- Group practices adding providers
- New practices enrolling with Medicare and Medicaid
- Groups facing revalidation or roster cleanup
60–150 days
Typical payer approval window
2 wks
Status update cadence
0
Lapsed attestations on our watch
How engagements work — Per-provider, per-payer pricing for new enrollment; flat monthly maintenance for roster and revalidation upkeep.
The problems we solve
Applications sit for months with no update.
Every application tracked with a payer contact log and a follow-up cadence until an effective date is issued.
Your CAQH profile is out of date and blocking approvals.
Full CAQH build-out, document upload, and attestation kept current on the 120-day cycle.
A provider started seeing patients before enrollment.
Start-date planning and, where payers permit, retroactive effective dates and linked claim holds.
You never revisited your contracted rates.
Fee schedule review against your payer mix, with renegotiation support where volume justifies it.
Full scope of work
Enrollment
- CAQH profile creation, upload, and attestation
- Medicare (PECOS) and Medicaid enrollment
- Commercial payer applications and group linkage
- NPI type 1 / type 2 setup and taxonomy alignment
Maintenance
- Revalidation and re-credentialing calendar
- Provider roster and demographic updates
- License, DEA, malpractice, and CME expiry tracking
- Add / terminate providers and locations
Contracts
- Contract and fee schedule review
- Rate negotiation support
- Payer mix and participation strategy
- Claim hold guidance during pending enrollment
Where the money comes back
Every engagement is scoped against a return: cost removed, margin recovered, cash pulled forward, or exposure closed.
Faster payer effective dates
A clean CAQH file and complete PECOS submission cut typical enrollment cycles by weeks. On a provider billing $40,000 a month, shaving three weeks off go-live is roughly $28,000 in claims that bill on time instead of pending.
Fewer denied claims from lapses
Expired attestations and missed revalidation windows trigger automatic payer holds. Preventing two lapse events a year on a $2M practice avoids an estimated $15,000-$25,000 in delayed or denied claims.
Better fee schedules, not just enrollment
Reviewing contract fee schedules at credentialing time, not after the fact, catches below-market rates before the first claim goes out. A one-point rate correction on $1.5M in contracted volume is $15,000 a year.
Multi-state expansion without downtime
Sequencing AHCCCS, commercial panel, and out-of-state enrollments in parallel instead of serially removes idle provider time. Avoiding one month of a provider sitting un-billable is worth their full monthly production.
What actually lands in your inbox
CAQH profile build and attestation
One-time (week 1), then quarterlyFull CAQH profile construction with supporting documents uploaded, plus the recurring 120-day attestation completed on time every cycle.
Medicare PECOS enrollment file
One-time per providerComplete PECOS application or update, including reassignment of benefits and any required supporting documentation for Medicare enrollment.
AHCCCS Medicaid application
One-time per providerArizona AHCCCS provider registration and any required managed-care plan enrollment, tracked through to approval.
Commercial panel application log
MonthlyA running log of every commercial payer application submitted, its status, and next action, updated monthly until closed.
Re-credentialing calendar
MonthlyA maintained calendar of every payer's revalidation and re-credentialing date with 90-day advance flags for each provider and license.
Roster and fee-schedule audit
QuarterlyA reconciled group roster against payer records, plus a fee-schedule comparison flagging any contracted rates below expected market range.
What working with us feels like
One CAQH file of record
We build and maintain the CAQH profile as the single source of truth, so every payer application pulls from the same current data instead of five conflicting versions.
No surprise re-credentialing
Every provider's revalidation and attestation date is on a tracked calendar with 90-day lead alerts, so nothing lapses because someone forgot a login.
Direct payer follow-up
We call payer provider-enrollment lines and escalate stalled applications directly instead of waiting on portal status updates that go stale for weeks.
Plain-language status updates
You get a status note in normal words, not portal screenshots: what's pending, what's blocking it, and the date we expect resolution.
Benchmarked against the usual option
- Application trackingSpreadsheet updated whenever someone remembersLive tracker with dated status on every open application
- CAQH maintenanceAttestation missed until payer flags itAttestation completed proactively before the 120-day window closes
- Fee-schedule reviewAccepted as sent, rarely checkedReviewed against market benchmarks before contract signature
- Multi-state expansionStarted one state at a time, sequentiallyApplications sequenced in parallel to cut idle time
- Revalidation riskDiscovered after a claim denialFlagged 90 days ahead on a maintained calendar
Your first 90 days
- Week 1
CAQH file built, gaps identified
We build or clean up the CAQH profile, pull current payer contracts and NPI/roster data, and produce a gap list of every missing document or expired credential.
- Day 30
Core applications submitted
PECOS, AHCCCS, and priority commercial panel applications are submitted with tracked confirmation numbers, and the re-credentialing calendar is populated for every active provider.
- Day 60
Follow-up and fee review underway
We are actively following up on pending applications by phone, and the fee-schedule review against contracted rates is complete with any renegotiation targets flagged.
- Day 90
Panels active, calendar running
Most submitted applications have an effective date on file, the revalidation calendar is running with automated lead-time alerts, and any expansion states are queued.
Platforms included
Configuration, integration, and day-to-day administration are part of the fee — you are not billed to keep your own systems running.
The cost of leaving it alone
Missed CAQH attestation window
Payers place providers on hold status, which suspends claim processing and can take four to six weeks to fully reinstate.
Revalidation deadline missed
Medicare or Medicaid can deactivate billing privileges, requiring a full re-enrollment rather than a simple update, which adds months of lost billing.
Fee schedule accepted unchecked
Below-market contracted rates lock in for the full contract term, compounding into six figures of underpayment across a multi-provider group.
How we run it
- 01
Inventory
Current panels, effective dates, and gaps documented in a single tracker.
- 02
Submit
Applications prepared, submitted, and confirmed received by each payer.
- 03
Chase
Scheduled payer follow-up with a written status update to you every two weeks.
- 04
Maintain
Attestations, revalidations, and expirables tracked so approvals never lapse.
Why clients choose us over the firm down the street
Status you can see
A live tracker per provider per payer — no more 'we submitted it somewhere'.
Biweekly written updates
You never have to ask where an application stands.
Paired with billing
Effective dates flow straight into billing so held claims release on time.
Expirables monitored
License, DEA, and attestation dates tracked so you don't fall off a panel.