Provider Credentialing and Payer Enrollment Services

Credentialing Functions We Manage

Credentialing is treated as a workflow, not a one-time form submission. Each application is owned, tracked weekly with the payer and escalated when responses fall outside expected windows.

• Initial provider credentialing across commercial and government payers
• Medicare PECOS enrollment, revalidation and reassignment
• Medicaid and Medicaid managed care plan enrollment
• CAQH ProView profile creation, attestation and quarterly maintenance
• NPI and taxonomy updates and group affiliations
• Re-credentialing calendar management with proactive renewals

Why Credentialing Slips and How We Prevent It

Credentialing delays usually trace to two operational gaps: incomplete or expired documents (license, DEA, malpractice, board certifications) and no system for tracking application status across multiple payers in parallel. We close both with a document repository, expiration calendar and weekly payer follow-up cadence per active application.

• Document expiration tracking with proactive renewal reminders
• Weekly payer follow-up with documented contact notes
• Escalation paths when applications stall past expected SLA
• Visibility for administrators into every active credentialing file

Coordination With Billing

Credentialing status feeds directly into our billing workflow so claims are not submitted under uncredentialed providers (a common cause of CO-B7 denials) and effective dates are captured for retroactive billing where payers allow it.