Credentialing
In network before the patient arrives
Credentialing is mostly waiting, and most of the waiting is caused by something that could have been done in the right order. We know the order.
CAQH, kept current
Registration, the profile itself, and the re-attestation every 120 days. An unattested profile reads to every payer as an incomplete application, and a payer that was never authorised cannot see it at all.
Commercial plans
The application, the supporting documents each payer wants, and the follow-up. Some want a portal, some want an email, one still wants a fax. Sending it the wrong way is how applications disappear.
Medicare enrollment
Initial enrollment, group enrollment, reassignment and revalidation, filed electronically through PECOS rather than on paper — which is the difference between roughly 45 days and roughly 100.
Medicare Advantage and Medicaid plans
In the right order. Both sit behind a government enrollment, and filing the plan application first guarantees a wait with nothing at the end of it.
Revalidation and panel watch
Approved is not finished. Enrollments expire, panels close and reopen, and a lapse found by a denial has already cost you a month of claims.
What you get, that you probably don't have now
One page showing every provider, every payer, and the state of each application — submitted, waiting, approved, panel closed, or never started. With the date each one is due a response and who to chase.
Every submission is logged with how it was sent, so when a payer says they never received it there is an answer rather than an argument.
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