From intake to approval and beyond
Every client goes through the same six-step process. It is designed to be thorough at the front end to prevent problems at the back end, and transparent throughout so you always know exactly where your applications stand.
Discovery and Intake
We begin every engagement with a structured discovery conversation to understand your practice, provider roster, target payers, states of operation, and timeline priorities. This conversation drives our enrollment strategy and helps us sequence applications to get you in-network with the highest-priority payers first.
- Practice profile review and payer gap analysis
- Provider document checklist specific to specialty and payer mix
- Secure document collection via encrypted client portal
- Enrollment priority sequencing based on your patient payer mix
- Timeline projection for each target payer
Profile Setup and Verification
Before submitting a single application, we build and verify a complete provider profile. We set up or update the CAQH ProView profile, verify NPI data in NPPES, confirm current license status through primary source verification, and resolve any data discrepancies before payers see them.
- CAQH ProView setup or audit and cleanup
- NPPES/NPI verification and taxonomy confirmation
- Primary source license verification
- DEA certificate and malpractice confirmation
- Work history and education documentation review
Application Preparation
We build payer-specific applications using your verified profile data. Each application is tailored to the exact requirements of the target payer, including payer-specific forms, supporting documentation requirements, and attestation language. Every application passes through a second-specialist review before submission.
- Payer-specific application forms completed in full
- Supporting documents matched to each payer requirement
- Dual-specialist review before any submission
- Electronic and paper applications for each applicable payer
- PECOS or Form 855 for Medicare applications
Simultaneous Multi-Payer Submission
We submit to all target payers simultaneously rather than sequentially. This parallel submission approach means a provider applying to 12 payers reaches all 12 on the same day, not after 12 sequential build cycles. We document submission confirmation for every application and begin tracking immediately.
- Parallel submission to all target payers
- Electronic submission via payer portals where available
- Paper submission with certified tracking where required
- Submission confirmation documented for every payer
- Real-time tracking log updated for client visibility
Active Follow-Up and Development
Credentialing does not stop at submission. We follow up with every payer on a defined schedule, respond to development letters and information requests within 24 hours, and escalate applications that exceed published timelines to our payer relations contacts. Most applications encounter at least one follow-up touchpoint before approval.
- Payer follow-up every 7 to 10 business days
- Same-day response to all payer information requests
- Development letter management and resubmission
- Direct escalation to payer provider relations contacts
- Client notification on every meaningful application update
Approval, Confirmation, and Maintenance
When approvals come in, we confirm effective dates, verify provider IDs and network participation status, and deliver a complete enrollment summary to the provider and billing team. We also calendar all revalidation dates and schedule ongoing maintenance services to keep every payer relationship active and current.
- Effective date confirmation with each payer
- Provider ID and network participation verification
- Enrollment summary delivered to billing team
- Revalidation calendar setup for all approved payers
- Ongoing maintenance scheduling for license and credential renewals
Why our process consistently outperforms in-house credentialing
The single biggest difference between our process and in-house credentialing is what happens between submission and approval. Most in-house coordinators submit applications and then wait, following up occasionally when they remember. Applications sit in payer queues for weeks without anyone checking their status.
Our specialists follow up with every open application every 7 to 10 business days. We document every payer interaction and escalate any application that exceeds the payer published processing timeline. That constant attention is what drives our average timeline reduction and what prevents months from passing before someone realizes an application was lost or stuck.
We also bring payer-specific knowledge that in-house teams rarely have. Knowing which development letters to take literally versus which ones allow flexibility, knowing which contacts at each payer actually move files, and knowing when to push and when to wait, those are skills that take years and thousands of applications to develop.
Questions about our process
How long does the entire credentialing process take from start to finish?
Timelines vary by payer type. Medicare typically approves in 60 to 90 days. Commercial payers range from 45 to 180 days. We typically have the fastest payers approved within 6 to 8 weeks of submission. Our proactive follow-up reduces total timeline by an average of 25% compared to unmanaged self-enrollment.
Can you start billing while credentialing is in process?
In some cases, yes. Some practices use retroactive billing clauses in contracts, bill self-pay and follow up for reassignment after approval, or use locum tenens arrangements. We advise on the options available for your specific situation during the intake process. This area involves compliance risk so it requires careful guidance.
How do I know what stage my applications are in?
You have access to our real-time application status tracking system from day one. You can see the status of every open application at any time, and we send proactive updates whenever there is a meaningful change. Our team also provides weekly summary emails for clients who prefer structured reporting.
What do you need from me once the process starts?
After completing the initial intake and document collection, your involvement is minimal. We handle all payer communication, application building, submission, and follow-up. We may occasionally need you to sign an attestation or provide a recently updated document, but most clients spend less than one hour per month on credentialing once we are engaged.
What happens when a payer sends a development letter or information request?
We receive and respond to all payer correspondence directly. When a payer requests additional information, we assess what is needed, pull the required information from our records or request it from the provider if it is something new, and respond within 24 hours. You are notified of any request that requires provider involvement.
Ready to put our process to work for your practice?
Contact us today for a free consultation. We will walk through our process for your specific situation and give you a realistic timeline and cost estimate for getting your providers credentialed and enrolled.