Credentialing & Appeals
Get credentialed.
Get paid.
Two things decide whether a practice collects what it earns: being in network before the patient walks in, and not writing off the claims that come back denied. We do both.
Credentialing
Enrollment is slow, and most of the delay is avoidable. A CAQH profile that lapsed its attestation, a payer that was never authorised to read it, an application sent to a panel that closed last year — each costs weeks, and none of them announces itself.
We hold documented submission routes for the payers practices here actually bill, including which ones have a prerequisite sitting in front of them.
What we handle →Appeals
A denial is not a decision. A large share of denied claims are never appealed at all — not because they would lose, but because nobody had time before the window closed.
Medicare gives you 120 days to ask for a redetermination, and only 30 days to stop recoupment once a demand letter lands. We work those dates, not the backlog.
How we appeal →How it works
01
We find out where you actually stand
Which payers each provider is credentialed with, which applications are sitting unanswered, and which denials are still inside their appeal window. Most practices have never seen this on one page.
02
We file, and we chase
Applications go to the right place the first time — the right portal, the right address, with the prerequisites already satisfied. Then someone follows up until there is an answer.
03
You see all of it
Every submission is logged with how it was sent and when a response is due. Nothing lives in one person's inbox.
Why it stalls
Most delays are a prerequisite nobody checked
Every Medicare Advantage plan requires the provider to be enrolled with Medicare first. Not as a convention — federal rule, and the identifier those plans ask for is only issued once CMS approves. Medicare enrollment takes 45 to 60 days electronically, longer on paper.
File the Advantage application before that lands and it cannot succeed. It will simply sit, and in two months somebody will ask why.
Medicaid plans have the same shape: state enrollment first, plan application second. Knowing the order is most of the job.
We also keep up with the paperwork that quietly changes. The CMS-855R reassignment form, for instance, was discontinued in 2023 — reassignment now goes on the 855I. Guides still tell people to file it.
Start with what you're owed
Send us a month of denials and your current credentialing status. We will tell you what is recoverable and what is stuck, before you commit to anything.
Talk to us