Credentialing and Contracting
Provider Credentialing and Payer Contracting Services
Credentialing delays directly suppress revenue — every uncredentialed day for a new provider is billable work that gets written off or held in suspense. Our team manages CAQH profiles, Medicare PECOS, Medicaid and commercial payer applications, then carries the file through payer contracting, fee schedule review and executed agreement tracking.
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
Payer Contracting Support
Being credentialed is not the same as being contracted on favorable terms. We manage the contracting side of the relationship — from initial participation requests through fee schedule review, amendment tracking and renewal windows — so practices know exactly what they have agreed to and what each payer is obligated to pay.
- New payer participation requests and network application follow-up
- Fee schedule review and comparison against Medicare benchmarks
- Contract rate negotiation support with documented talking points
- Amendment, addendum and escalation-clause tracking
- Renewal and termination-window calendar management
- Executed contract repository with effective dates recorded for billing
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 and contract status feed directly into our billing workflow so claims are not submitted under uncredentialed providers (a common cause of CO-B7 denials), contracted rates are loaded correctly and effective dates are captured for retroactive billing where payers allow it.
Measurable Outcomes Our Clients Track
Reduced credentialing turnaround time
Lower CO-B7 credentialing-denial volume
Proactive re-credentialing with no lapses
Contracted rates verified against payment posting
Visibility into status of every application and contract
Faster revenue capture on new provider start dates
Care Settings We Deliver This For
This service is delivered with workflows tuned to each care setting's payer rules and documentation requirements.
- Physician Practices Credentialing & Contracting Services
- Multi-Specialty Clinics Credentialing & Contracting Services
- Hospital Credentialing & Contracting Services
- Behavioral Health Providers Credentialing & Contracting Services
- Home Health Agencies Credentialing & Contracting Services
- Skilled Nursing Facilities Credentialing & Contracting Services
- Urgent Care Centers Credentialing & Contracting Services
Discuss Your Revenue Cycle Goals
Speak with our team about how credentialing & contracting services can be structured around your specialty, payer mix and current performance benchmarks.