Service

Provider credentialing and payer enrollment

You cannot bill a payer you aren't enrolled with. We handle enrollment, CAQH, revalidation, and contracting so revenue starts on time and never lapses.

Get a free A/R analysis Book a 15-minute call

The problem this fixes

Credentialing is the most expensive administrative failure in a practice because it stops revenue before it exists. A new provider who isn't enrolled can't bill. A lapsed revalidation can retroactively invalidate months of claims. A missed CAQH attestation can drop a provider from a payer's directory without warning.

The process is slow by design — 60 to 180 days depending on the payer — and it's almost entirely deadline management.

It is also the failure that compounds fastest in a growing practice. Every new provider adds a set of enrolment timelines, revalidation dates, attestation deadlines and expiring documents. A practice that manages this as a stack of applications rather than a tracked pipeline will eventually miss one, and a single missed revalidation can invalidate months of claims for that provider retroactively.

What goes wrong when this is done badly

Four failure modes we see repeatedly, and each one is a process problem rather than an effort problem.

Starting too late

Commercial enrolment routinely takes 60 to 180 days. Applications submitted the month before a provider starts guarantee a revenue gap that lands exactly when a new practice can least absorb it.

No follow-up cadence

An application with a missing item that nobody flagged will sit indefinitely. Elapsed time in credentialing is determined more by who is chasing than by the payer's stated committee cycle.

Letting CAQH lapse

Re-attestation is required every 120 days and reminders go to whichever email is on the profile — often a departed employee. A lapsed profile stalls every commercial application at once, silently.

Signing the fee schedule unread

A rate ten percent below market compounds across every claim for the life of the contract. Reviewing it costs days; living with it costs years.

What's included

Every item below is a deliverable, not a capability statement.

Initial payer enrollment

Across Medicare, Medicaid, and commercial plans.

Medicare PECOS enrollment and revalidation

Including the five-year revalidation cycle.

Medicaid enrollment

State by state, to each programme’s own rules.

CAQH ProView management

Profile setup, maintenance, and quarterly re-attestation.

Primary source verification

Education, training, licensure, board certification, and work history.

NPI registration

Type 1 (individual) and Type 2 (organisation).

Payer contracting and fee schedule review

Reviewed before you sign, not after.

Hospital privileging support

Applications assembled and tracked.

Re-credentialing and revalidation tracking

Dates monitored with advance alerts.

Expirable document monitoring

Licence, DEA, malpractice, and board certification.

Group and location additions

New sites and new providers added to existing contracts.

Delegated credentialing support

For larger groups operating under a delegation agreement.

How it works

1 Document collection We gather every required document once and maintain it centrally.
2 CAQH build Profile completed, attested, and set to auto-remind.
3 Application submission Applications filed payer by payer, tracked individually.
4 Follow-up We chase payers on a fixed cadence — this is where most credentialing stalls.
5 Contract review Fee schedules reviewed before you sign.
6 Ongoing monitoring Expirations and revalidation dates tracked with advance alerts.

What typically holds credentialing up

Stage	Typical duration	Where it stalls
Document collection	1–2 weeks	Missing malpractice face sheets and gaps in work history
CAQH build and attestation	1–2 weeks	Profile left un-attested, so payers cannot pull it
Medicare (PECOS)	30–90 days	Returned applications over signature and address mismatches
Medicaid	60–180 days	State-specific forms and separate managed-care enrollments
Commercial plans	60–180 days	No follow-up cadence — applications sit in a queue
Contract and fee schedule	2–6 weeks	Fee schedule signed without review

Durations vary by payer and state. We confirm each effective date in writing.

What you get back

A live credentialing status dashboard by provider and payer
Advance alerts on every expiring document
A central document repository
Effective dates confirmed in writing

Who this is for

New and startup practices that cannot bill until enrollment completes
Groups adding providers, locations or new payer contracts
Practices that have had a revalidation or attestation lapse
Practices renegotiating below-market fee schedules

What we measure

The numbers this service actually moves. You see all of them weekly, in your own system, with the benchmark alongside.

Days to effective date Measured from application submission to the payer confirming an effective date, per payer. It is the number that tells you when a provider can start billing, and it is the only credentialing metric that maps directly to revenue.
Applications pending by age How long each open application has been sitting, by payer. Applications do not progress on their own, and this is what turns follow-up into a cadence rather than a memory.
Expiring documents in the next 90 days Licences, DEA registrations, malpractice certificates, board certifications and CAQH attestations, per provider. Every one of these can stall enrolment silently.
CO-B7 denial volume Claims denied because a provider was not enrolled or the effective date was wrong. It should be zero, and when it is not, it usually points at one specific gap.

Benchmark ranges are sourced from MGMA and HFMA MAP Keys. MedBil's own figures are published only with a stated measurement window, per specification section 12.7.

Where this matters most

The specialties where this part of the cycle carries the most risk and the most recoverable revenue.

Gastroenterology Screening vs. diagnostic colonoscopy, modifier 33/PT, auth Dermatology Lesion coding by size and site, cosmetic vs. medical, pathology Physical Therapy Timed vs. untimed units, the 8-minute rule, therapy caps, plan of care Urgent Care High volume, S-codes, place of service, self-pay mix OB/GYN Global obstetric package, antepartum/postpartum splits, ultrasound Wound Care Debridement by depth, skin substitutes, HBOT, documentation of measurements

Proof

Start with your own numbers

We measure your denial rate, A/R ageing and net collection rate against industry benchmarks before you commit to anything. You keep the analysis either way.

90 days of claims data, no patient identifiers needed
A written analysis, not a sales deck
No contract, and no obligation to proceed
Client results published with a stated measurement window, once available

Questions about provider credentialing & payer enrollment

How long does credentialing take?

Typically 60–180 days depending on payer and state. Medicare is often faster than commercial plans.

Can I bill for services before enrollment is effective?

Generally no. Some payers allow retroactive effective dates — we pursue those where available.

What is CAQH and why does it matter?

A shared credentialing database most commercial payers pull from. If your profile lapses, enrollment stalls.

Do you handle Medicare revalidation?

Yes, including PECOS updates and the five-year cycle.

Can you renegotiate my existing payer contracts?

We review fee schedules and identify below-market rates. Renegotiation is available where a payer permits it.