Est. 2014 Bridging Healthcare & Revenue
✉ info@carebridgercmsolution.com 📞 022-39482200
OPERATIONAL METHODOLOGY

Specialized Execution Built for Healthcare Organizations

Uncredentialed providers cannot bill insurance plans, leading to delayed revenue and lost patient volume. CareBridge's Credentialing and Provider Enrollment service manages the entire payer enrollment lifecycle for physicians, nurse practitioners, physician assistants, and clinical facilities.

We manage initial applications for Medicare, Medicaid, and major commercial insurance networks, maintain CAQH ProView profiles, monitor primary source verifications, and track re-credentialing deadlines to ensure zero lapse in network participation.

MEASURABLE PRACTICE OUTCOMES
  • ✓ Prevents unbillable provider downtime and claim hold-ups
  • ✓ Accelerates initial payer approval cycles by 30 to 45 days
  • ✓ Eliminates out-of-network claim denials due to lapsed credentialing
  • ✓ Maintains 100% up-to-date CAQH and government portal attestations
SERVICE PERFORMANCE BENCHMARKS
< 90 Days
Average Payer Enrollment
100%
CAQH Attestation Compliance
0
Credentialing-Related Denials
180 Days
Proactive Renewal Lead Time
STRUCTURED WORKFLOW

Execution Stages

01 Provider documentation gathering (licenses, DEA, board certifications, malpractice insurance)
02 Application preparation and submission via PECOS, state Medicaid, and commercial payer portals
03 Weekly follow-up with payer credentialing committees until approval and contract execution
04 Entering effective billing dates and provider IDs into practice management software
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PROBLEM RESOLUTION

Specific Challenges Solved by Credentialing & Provider Enrollment

We eliminate operational bottlenecks and financial friction points across your revenue cycle.

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Lengthy Payer Approval Times

Weekly follow-up with payer enrollment analysts ensures applications do not stall in administrative queues.

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Lapsed Payer Re-Credentialing

Automated tracking initiates re-credentialing 180 days in advance, preventing network drops.

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Complex Multi-State Enrollment

Our team navigates diverse state Medicaid and regional commercial payer guidelines for expanding practices.

TECHNICAL SCOPE

Comprehensive Workflow Capabilities

Detailed operational deliverables included in our Credentialing & Provider Enrollment engagement models.

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Initial commercial payer, Medicare (PECOS), and state Medicaid enrollment applications
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CAQH ProView profile creation, quarterly attestations, and document updates
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National Provider Identifier (NPI Type 1 & Type 2) registration and updates
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Hospital privilege application coordination and primary source verification
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Payer contract fee schedule tracking and effective date verification
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Automated re-credentialing calendar alerts and license expiration tracking
SEAMLESS TECHNICAL INTEGRATION

Compatible with Leading Healthcare EHR & Practice Management Platforms

Epic Systems Cerner / Oracle Health Athenahealth eClinicalWorks (eCW) Kareo / Tebra NextGen Healthcare AdvancedMD DrChrono Allscripts / Veradigm
FREQUENTLY ASKED QUESTIONS

Credentialing & Provider Enrollment FAQs

Common questions regarding our operational workflows and transition process.

Q: How long does payer credentialing typically take?

Commercial payers typically take 60 to 90 days, while Medicare and Medicaid take 45 to 90 days. Our weekly follow-up protocol ensures applications move as fast as possible.

Q: Do you maintain our CAQH profiles?

Yes. We keep your CAQH profile fully current, uploading renewed licenses, DEA certificates, and malpractice coverages, and completing mandatory quarterly attestations.

Q: Can you credential new providers joining our existing group?

Yes. We link new clinicians to your group NPI and tax ID across all contracted payer networks seamlessly.

TRANSFORM YOUR RCM PERFORMANCE

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