What happens after you say go.

Before anything is filed, we find out what your records actually say.

We pull the current state of every record a payer will read: NPI and NPPES entries, the CAQH profile and its attestation date, state licenses, DEA, malpractice coverage and limits, existing enrollments, and how each provider links to the group TIN. Then we compare those records against each other, because payers do. An address that reads one way in NPPES and another way on the application is not a typo to a payer. It is a mismatch, and mismatches stall quietly. Most engagements find something here, and finding it now is free. Finding it after submission costs a full payer cycle.

One process applied to twenty payers is how applications stall.

Each application is built to the target payer's current requirements from our maintained playbooks rather than a generic template. Aetna is built contract first, because that is how Aetna sequences it. Humana leads with CAQH, because Humana requires it in every state except Arkansas. UnitedHealthcare behavioral health routes to the separate Optum process instead of the medical network. The five year work history is computed from the CV rather than eyeballed, and every gap longer than six months carries a written explanation before a payer has to ask for one.

Nothing leaves the building until it passes a written pre-submission check.

Once the file clears the gate, it goes through the channel that payer genuinely processes: portal, CAQH pull, delegated roster file, or paper where a payer still insists on it. Medicare goes through PECOS on the web rather than paper wherever possible, because paper form versions go stale and an outdated 855 comes back unread, costing 60 to 90 days for nothing. We keep proof of submission and the reference number for every file, because payers lose applications more often than anyone admits, and the date of record is what retro billing stands on.

Payers do not proactively tell you anything. The cadence is the product.

Receipt is confirmed in week one with the reference number in writing. The complete application acknowledgment date gets logged, because that date is the legal trigger for state prompt credentialing clocks. A first status check lands between day 14 and 21, then a touch every 10 to 14 days, tightening to weekly inside the final 30 days of the payer's own quoted window. Every touch is logged with the analyst's name, the exact status wording, what is outstanding, and the next promised date. A deficiency letter answered in three days instead of three weeks is where the saved months actually come from.

Approved is not done. Paid is done.

We get the network effective date and the contract and fee schedule linkage confirmed in writing, because a verbal effective date has a way of moving once claims start denying, and the written one is what an appeal stands on. Then we finish transaction enrollment: ERA and EFT per payer, plus the CMS-588 and the separate MAC EDI agreement on the Medicare side. The clearinghouse leg takes 3 to 5 business days. Payer side activation runs 2 to 6 weeks per payer and sits in a different queue than credentialing, which is exactly why so many practices end up approved and unpaid at the same time.

Credentialing is not a project that ends. It is a system that runs or decays.

CAQH re-attestation every 120 days. Recredentialing on each payer's own cycle, three years at Aetna and Humana among others. Medicare revalidation on its separate clock. License, DEA, and malpractice expirables with lead times rather than due dates. Exclusion screening against the federal and state lists. All of it sits on a standing calendar with a named owner, because every one of these lapses the same way: quietly, and then all at once when a claim denies or a network sends a termination letter with a retroactive date on it.