Service
Provider Credentialing
Applications, CAQH, PECOS and contracts — with expirables calendared so nothing lapses.
A lapsed credential turns every claim behind it into a write-off.
What breaks here
Credentialing goes wrong in two ways. The first is slow: an application stalls at a payer, nobody follows up on a schedule, and a new provider spends four months seeing patients whose claims cannot be billed.
The second is worse because it is silent. A license, DEA registration or malpractice policy expires. Nothing announces it. Claims keep going out and keep getting denied, and by the time somebody traces the pattern, a chunk of them have passed timely filing.
What we do about it
Every application is tracked by payer with an expected turnaround, and followed up on a schedule rather than when someone remembers. You can see the status of each one without asking.
Expirables are calendared with lead time — licenses, DEA, malpractice, board certification, CAQH attestation. The reminder goes out before the date, not after the denials start.
Precertification absent
Ask any billing company this
“How do you track expirables, and what happened the last time one lapsed on a client?”
The second half of that question is the useful half. Everyone has a system; not everyone has a story.