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Credentialing & Compliance
An uncredentialed provider is an unbillable provider.
Every week a new hire spends outside a payer network is a week of revenue you will never recover. We run enrollment, CAQH, revalidation and the compliance layer underneath it — and we chase the payers so your office manager does not have to.
The Cost of Waiting
Credentialing is the slowest thing that blocks your fastest revenue
A physician you hired in January and could not bill for until June did not cost you a delay. They cost you five months of a full schedule, plus the salary you paid anyway.
A single missed CAQH attestation or an unanswered payer email can add six weeks to a file nobody is watching.
Conservative estimate of billable revenue a mid-volume provider cannot generate while out of network.
A revalidation deadline that slips does not slow payment down — it stops it, retroactively, across every payer affected.
Multiplied by 25 payers per provider, this is a full-time job your office manager is doing between phone calls.
Scope of Work
Enrollment, maintenance and the compliance layer
Credentialing is not a one-off task you finish. It is a calendar you have to keep — and a compliance posture you have to be able to prove.
Initial Provider Enrollment
Commercial, Medicare and Medicaid applications prepared, submitted and tracked from day one — with the document checklist handled up front so nothing bounces.
CAQH Profile Management
Profile built, kept current and re-attested every quarter. An expired attestation is the single most common reason an application stalls silently.
NPI, PECOS & Licensure
NPI registration and updates, PECOS enrollment and revalidation, state licence and DEA tracking — all held in one record with expiry alerts.
Re-Credentialing & Revalidation
Every payer's cycle tracked on a rolling calendar and actioned months ahead of the deadline, so enrollment never lapses and claims never stop.
Group & Facility Enrollment
Group NPI setup, provider linkage to the tax ID, new location additions and roster maintenance across every payer you contract with.
Contracting & Fee Schedules
Participation requests, contract review support and a plain reading of the fee schedule you are being offered — before you sign it.
HIPAA Compliance Support
Risk assessment support, policy templates, workforce training records and access-control review — the evidence you need if anyone ever asks.
Coding & Documentation Audits
Quarterly internal audits on coding accuracy and documentation sufficiency, so an external reviewer never finds something you did not already know about.
Status Reporting
A live tracker per provider per payer — submitted date, current stage, last contact, expected effective date. No more asking where things stand.
Timeline
What actually happens, week by week
Credentialing timelines are set by the payer, not by us. What we control is that nothing sits waiting on our side and that you always know exactly which stage each application is in.
Document collection
We send one consolidated checklist — licence, DEA, board certification, malpractice, W-9, CV with no gaps, bank details. One list, once, not a trickle of requests over three weeks.
You provide documentsCAQH build & attestation
Profile created or cleaned up, every section completed, malpractice history reconciled and the profile attested — then set to auto-remind every 120 days.
TopMed handlesApplications submitted
All payer applications go out together, not sequentially. Medicare and Medicaid first because they take longest, commercial payers in parallel.
TopMed handlesWeekly follow-up
Every payer contacted weekly, with the representative's name and a reference number logged. Missing-information requests answered within one business day.
TopMed handlesApprovals & effective dates
Contracts reviewed, effective dates confirmed in writing and retroactive dates pursued where the payer allows. Your billing team gets the go-live date before it arrives.
TopMed handlesMaintenance calendar
Revalidation dates, licence expiries, CAQH re-attestations and roster updates tracked on a rolling calendar — actioned months before anything can lapse.
TopMed handlesCompliance
Built to survive a review, not just pass an inspection
Compliance is not a binder on a shelf. It is whether you can produce the evidence on the day someone asks for it.
HIPAA safeguards
Signed BAA, encrypted transmission and storage, named role-based accounts and access revoked the day someone leaves your account.
Full audit trail
Every record touched, every claim edited, every note added — logged with a user and a timestamp you can export at any time.
Quarterly coding audits
A statistically valid sample reviewed against documentation each quarter, with findings written up and fed back into coder training.
Trained workforce
Mandatory HIPAA and fraud-waste-abuse training on hire and annually after, with completion records held per staff member.
Credentialing FAQ
Straight answers on enrollment
Hiring a provider soon?
Start the file before their first day. Every week gained at the front of the process is a week of billable schedule at the back.
Begin CredentialingHow long does credentialing actually take?
Can we bill for services provided before approval comes through?
Do you handle credentialing if we do our billing in-house?
What documents will you need from each provider?
What happens if a revalidation deadline is missed?
Can you add a new location or a new group tax ID?
How do you charge for credentialing?
Free Revenue Audit
Find out what your practice is leaving on the table
Send us a claim sample and your A/R aging report. Within 48 hours you get a written breakdown — no cost, no obligation, no sales pressure.