Credentialing & Payer Enrollment

Provider Credentialing and Payer Enrollment Support

Application Coordination CAQH Workflow Re-Credentialing Status Follow-Up

Overview

Credentialing and payer enrollment require accurate provider information, complete supporting documents, and follow-up with each payer. Processing timelines and requirements vary by payer and application.

Rafsons Med Billing can discuss application preparation, CAQH profile coordination, status follow-up, re-credentialing, and group roster workflows with your organization.

Enrollment decisions and effective dates are determined by the payer. Confirm each provider's status before scheduling or billing services under a network contract.

Possible Service Activities

Enrollment Coordination

Discuss application preparation, payer follow-up, and status reporting with your practice team.

CAQH Workflow Support

Review whether CAQH profile coordination and attestation support fit the agreed scope.

Contracting Discussions

Ask about contract review or negotiation coordination; scope and authority must be agreed in writing.

Renewal Tracking

Discuss tracking for re-credentialing and document expiration dates supplied by your practice.

Payer Enrollment

Discuss the Medicare, Medicaid, and commercial payer applications relevant to your practice.

Roster Coordination

Coordinate provider roster or location updates with the practice and payer, when included in scope.

How Work May Be Organized

Confirm Requirements

Identify payer, provider, and jurisdiction requirements for the requested enrollment work.

Coordinate Information

Collect only the provider information and supporting documents required for the agreed application workflow.

Prepare the Application

Prepare application materials using information reviewed by the provider or authorized practice contact.

Submit and Track

Submit through the agreed channel and record payer requests, responses, and outstanding items.

Confirm Payer Status

The payer determines approval and effective dates. Verify status with the payer before relying on network participation.

Frequently Asked Questions

How long does credentialing typically take?+

Timelines vary by payer, application completeness, provider history, and jurisdiction. We can review the application status and provide a case-specific estimate, but cannot guarantee payer processing times.

Can you handle credentialing for new practices?+

Yes. We work with new practice startups, established groups, hospitals, health systems, urgent care networks, and individual providers joining existing groups.

Do you negotiate reimbursement rates with commercial payers?+

Ask us about contract review and negotiation support. Any rate change depends on the payer, contract terms, and the parties' negotiations.

What happens if a payer denies our credentialing application?+

We investigate the reason for denial, address any deficiencies, and resubmit with supporting documentation. We also explore alternative network participation options while pursuing re-enrollment.