Credentialing & Enrollment
Credentialing is a sequence. Skip a step and the claim does not pay.
Enrollment fails in predictable places: a missing document, an unattested CAQH profile, an application nobody followed up on, a contract that was approved but never loaded. MBS runs credentialing as a tracked ladder with a named owner, so every provider has a status you can see and a date you can bill against.
Every payer application tracked to a decision, not to a submission date.
One named credentialing lead per practice.
Revalidation and re-credentialing dates owned before they expire.
THE PROCESS
Six steps, in order, with the follow-up owned
Nothing here is exotic. What practices are usually missing is not knowledge of the steps — it is someone whose job is to finish them in sequence and chase the payer until a decision exists.
Document intake and gap review
Before anything is submitted we build the provider file and tell you exactly what is missing. Most credentialing delays are a missing document discovered three weeks in, not a payer being slow.
- License, DEA, board status, malpractice, W-9, and CV collected in one pass
- Gaps in work history and any adverse-action history addressed up front
- Group-level items — tax ID, NPI, addresses, ownership — verified once and reused
CAQH and primary source setup
CAQH is where most payers read the provider from, so it gets built correctly and attested on schedule rather than corrected after a denial.
- CAQH profile built, attested, and re-attested on the required cycle
- Primary source verification assembled to payer standards
- NPPES, PECOS, and state enrollment records aligned to the same data
Why this step slips
CAQH attestation lapses quietly. The profile still exists, the payer just stops reading it as current — and the next application stalls without an obvious reason.
Payer applications submitted in priority order
We sequence by payer mix, not alphabetically. The payers carrying most of your volume go first so billable dates start moving sooner.
- Commercial, Medicare, Medicaid, and managed-care plans each to their own process
- Application copies and submission confirmations retained per payer
- Roster adds handled through delegated processes where a payer allows them
Why this step slips
Applications get filed in whatever order they were requested, so the payer carrying half your volume ends up last in the queue.
Follow-up until a decision exists
This is the step practices lose. A submitted application is not progress. We work an aging list of open applications on a fixed cadence and escalate when a payer stalls.
- Status checked on a scheduled cycle, with contact and reference numbers logged
- Escalation to provider reps when an application sits beyond the payer's stated window
- Effective dates confirmed in writing, including retroactive dates where available
Follow-up desk
Applications worked on a schedule, not on hold
Contract load and billing readiness
Approval is not the finish line — the contract has to be loaded and the provider linked to the group before a claim will pay. We confirm both before you bill.
- Fee schedule and contract load verified with the payer
- Provider linked to the correct group, location, and tax ID
- Billing team notified of live dates so held charges release in the right order
Why this step slips
An approval email is treated as a green light. If the contract was never loaded, or the provider was never linked to the group, the claim still denies.
Revalidation and re-credentialing calendar
Every credential has an expiration. We keep the calendar and start the work early, so nothing turns into a mid-quarter shutdown of a payer's payments.
- License, DEA, and malpractice expirations tracked per provider
- Medicare revalidation and payer re-credentialing started ahead of deadline
- Demographic and location changes filed with every affected payer
Why this step slips
Expirables are tracked in a spreadsheet nobody owns. The first sign of a problem is a payer holding payments mid-quarter.
WHAT YOU GET
Included in a credentialing engagement
- Initial provider credentialing and enrollment
- Group and facility enrollment (new tax IDs, new locations)
- CAQH build, attestation, and maintenance
- Medicare and Medicaid enrollment and revalidation
- Commercial and managed-care applications
- Contract load and fee schedule confirmation
- Re-credentialing and expirable tracking
- Demographic, address, and ownership updates
- Roster adds and terminations
- Status reporting per provider, per payer
Built around your roster, with clear edges
Payer list, roster size, and reporting cadence are shaped to your group. A few items stay with your team or the facility, and we say so up front:
- Contract rate negotiation as a standalone service (scoped separately)
- Licensure applications with state boards
- Hospital privileging decisions, which stay with the facility
How you can tell it is actually being worked
Credentialing is easy to fake for a few weeks. These are the artifacts that make progress checkable rather than reported.
Per provider, per payer
Status reporting so you always know which applications are open, pending, or live.
Fixed follow-up cadence
Open applications worked on a schedule instead of when someone remembers.
Dates in writing
Effective dates confirmed with the payer before charges are released.
Credentialing questions, answered honestly
How long does credentialing take?
It depends on the payer, and honest answers vary widely — some commercial plans move in weeks, government and managed-care processes can take considerably longer. We will not quote you a timeline we do not control. What we do commit to is that every application is followed up on a fixed cadence and that you can see its status at any point.
Can you get retroactive effective dates?
Sometimes. Certain payers allow retroactive dates, others do not, and the window varies. We request it whenever it is available and tell you plainly when it is not, so charges can be held or written off deliberately rather than by surprise.
Should we hold claims while credentialing is pending?
Usually yes, and we coordinate that with your billing workflow so held charges are released in the right order once effective dates are confirmed — instead of being submitted early, denied, and then aging.
Do you handle new locations and new tax IDs?
Yes. Group-level enrollment is a separate track from individual providers, and it is where multi-location practices most often get stuck. We manage both and keep the data consistent across them.
Can credentialing be bought without billing?
Yes. Credentialing is offered as a standalone engagement. It also works well alongside billing, because confirmed effective dates and clean provider linkage remove a large share of avoidable enrollment denials.
Where credentialing connects
Revenue Cycle Management
The full cycle under one owner, with credentialing folded into the same reporting.
Medical & Chronic Care
High-volume outpatient billing where clean provider linkage decides first-pass rates.
All specialties
Five billing models, grouped by how the revenue cycle actually behaves.
Send us your open enrollment list
We will tell you which applications are actually stalled, which are waiting on a document you already have, and which providers can be billing sooner than you think.
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