Solution: Credentialing Delays
Every week a physician, PA, or NP waits for payer enrollment is a week of lost revenue. At an average of $8,000–$15,000 in weekly collections per provider, a 12-week credentialing delay costs your practice $96,000–$180,000 in deferred revenue.
Root Causes
Credentialing delays are almost entirely caused by administrative bottlenecks — most of which are preventable with a dedicated, organized process.
Payers return applications with missing documents — CAQH profile not current, DEA certificate expired, hospital privileges letter missing. Each return resets the clock by 2–4 weeks.
Most payer applications feed from CAQH. An outdated CAQH profile (expired malpractice certificate, old address) causes silent application failures that aren't discovered until weeks later.
Payer credentialing departments process applications in the order received — unless someone calls to check status and flag urgent timelines. Unmonitored applications sit in queues indefinitely.
Most payers allow retroactive billing from the application submission date (not the approval date) if requested correctly. Practices unaware of this policy lose 4–12 weeks of billable revenue unnecessarily.
Adding a provider to a group NPI requires both individual and group enrollment to be aligned. A mismatch causes claims to deny even when the individual credentialing is complete.
Our Approach
We gather every document required for all target payers simultaneously — CAQH update, DEA, licenses, malpractice certificates, CV, hospital privileges, and taxonomy codes. One intake, not piecemeal.
Applications submitted to all target payers simultaneously — not sequentially. For providers with commercial payer priority, Medicare/Medicaid enrollment runs in parallel.
Dedicated credentialing specialist contacts each payer weekly to confirm receipt, check status, and flag urgent cases. Missing documents are turned around within 24 hours.
We request retroactive billing from the application date with every payer that allows it — capturing revenue for services rendered during the enrollment period.
Credentialing is not a one-time event. Most payers require re-credentialing every 3 years. RCMAXIS tracks expiration dates and initiates re-credentialing automatically — before gaps occur.
Client Results
Start the credentialing process now — not when they walk in the door. Contact RCMAXIS to begin enrollment 4–6 weeks before a provider's start date and ensure Day 1 billing.