Comprehensive ongoing credentialing maintenance
Credentialing is not a one-time event. Every license, certification, and payer enrollment has an expiration date. We track them all so you never have to.
Medicare Revalidation Management
CMS requires Medicare revalidation every 3 to 5 years depending on provider type. We track each provider individual revalidation due date and begin the process 90 days before deadline to avoid any disruption in Medicare billing privileges.
Medicaid Revalidation Tracking
State Medicaid revalidation cycles vary by state, typically every 3 to 5 years. We monitor every state-specific deadline across all states where a provider is enrolled and manage the complete revalidation submission process.
Commercial Payer Re-Credentialing
Most commercial payers re-credential providers every 2 to 3 years under NCQA standards. We track each payer specific re-credentialing cycle and proactively submit updated information before the payer initiates the process.
License and Certification Renewal Tracking
We monitor expiration dates for state medical licenses, DEA registrations, board certifications, and malpractice insurance policies, alerting providers well in advance and updating all payer and CAQH records once renewals are received.
CAQH Quarterly Attestation
CAQH ProView requires attestation every 120 days. We complete this on schedule for every active provider, preventing the profile inactivation that halts payer access to credentialing data and stalls pending applications.
Demographic and Practice Update Management
When a provider changes practice location, adds a specialty, joins a new group, or updates contact information, that change must be reflected across CAQH, NPPES, PECOS, and every payer file. We manage these updates comprehensively across all systems.
The real cost of a missed revalidation deadline
A missed revalidation deadline is not a minor administrative slip. The consequences are immediate, financially significant, and can take months to fully resolve.
Medicare Deactivation
Missing Medicare revalidation results in automatic deactivation of billing privileges. Claims submitted during a deactivation period are denied, and reinstatement requires a new enrollment process that can take months to complete.
Medicaid Termination
States terminate Medicaid enrollment for providers who do not revalidate on schedule. Reapplication after termination often means starting from scratch with a new application, losing the benefit of the existing enrollment history.
Commercial Network Removal
Commercial payers remove providers from their network directories when re-credentialing is not completed. Patients searching for in-network providers will no longer find the practice, directly impacting new patient volume.
CAQH Profile Inactivation
An expired CAQH attestation marks the profile inactive across the entire CAQH system used by over 1,000 payers and health plans. Any pending credentialing application halts the moment a payer pulls inactive CAQH data.
How our maintenance system prevents missed deadlines
Every provider we manage has a complete revalidation calendar built from day one of engagement. This calendar tracks every individual deadline, Medicare revalidation, Medicaid revalidation in every enrolled state, commercial payer re-credentialing cycles, license expirations, DEA renewal dates, malpractice policy terms, and CAQH attestation windows.
Our system flags upcoming deadlines automatically, triggering proactive outreach well before any cutoff. For Medicare and Medicaid, we begin work 90 days in advance. For CAQH, we act two weeks before the 120-day window closes. This buffer ensures we have time to resolve any complications, such as a delayed license renewal or missing document, without risking the actual deadline.
For our active maintenance clients, we maintain a track record of zero missed revalidation deadlines. That reliability is the entire point of outsourcing this function. A single missed Medicare revalidation can cost a practice tens of thousands of dollars in denied claims during the deactivation period, far more than the cost of ongoing maintenance service.
A look inside our revalidation tracking approach
Reliable revalidation management depends on a disciplined tracking system, not memory or good intentions. Here is how we structure that system for every active provider.
Medicare and Medicaid revalidation outreach begins. We gather updated documentation and confirm current provider information.
Application preparation completed and queued for submission, with any outstanding documentation requests escalated to the provider.
Submission completed and confirmation obtained. We begin standard follow-up tracking against the published deadline.
CAQH ProView attestation completed for the 120-day cycle, with all documents and information verified as current.
Maintenance services fit any practice with active payer enrollment
Any provider with active Medicare, Medicaid, or commercial payer enrollment benefits from dedicated revalidation tracking. The risk and complexity grows with every additional payer and every additional state, making maintenance especially valuable for larger or multi-state organizations.
Revalidation and maintenance questions answered
How far in advance do you begin the revalidation process?
We begin Medicare and Medicaid revalidation 90 days before the published deadline, giving ample time to gather updated documentation and resolve any issues before the cutoff. For CAQH attestation, we complete the process approximately 2 weeks before the 120-day window closes.
What happens if I am already past a revalidation deadline?
If a deadline has already passed, we move urgently to complete the revalidation or reinstatement process. The specific path depends on the payer and how long the deadline has been missed. We will assess your situation immediately and outline the fastest path back to active status.
Do you track revalidation deadlines for all my payers automatically?
Yes. Once you engage our maintenance service, we build a complete revalidation calendar covering Medicare, Medicaid in every state where you are enrolled, and every commercial payer contract. This calendar is monitored continuously and triggers action well before any deadline.
Is revalidation management included with initial credentialing services?
Yes. Ongoing maintenance including revalidation tracking is included for all providers we initially credential. For providers who completed their original enrollment elsewhere, we offer standalone revalidation and maintenance services to take over ongoing tracking.
How much provider involvement is required for revalidation?
Minimal. We handle the application preparation and submission. Providers typically need only to confirm current information is accurate and provide any updated documents such as a renewed malpractice certificate or license, usually requiring less than 30 minutes of their time per revalidation cycle.
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Protect your credentialing investment
Contact us today to set up comprehensive revalidation tracking for your providers. We will build your complete deadline calendar and ensure nothing ever lapses again.