FULL CREDENTIALING SERVICES FOR FQHCS
For Federally Qualified Health Centers, credentialing isn't just paperwork; it's the difference between providers who can bill and providers who can't. Between care that reaches patients and care that stalls. Between financial stability and cash flow chaos.
The problem? Most health centers manage credentialing manually, with no centralized tracking, no payer escalation, and no visibility into where applications stall.
The cost? $25,000–$60,000 in lost billing per provider. Patients waiting weeks for appointments. HRSA audit risks that put your funding at stake.
Healthcare Revenue Group has supported FQHCs for 26 years with health center credentialing services that eliminate delays, ensure HRSA compliance, and protect your revenue from day one.
Why Credentialing Delays Are Costing Your Health Center Thousands
When credentialing stalls, everything backs up:
- New hires can't see patients even though they're on payroll
- Medicaid claims get denied because enrollment isn't complete
- Existing providers face billing gaps when recredentialing runs late
- HRSA site visits reveal compliance issues that threaten your funding
Across FQHCs nationwide, credentialing and payer contracting take 90–120 days or longer—especially with Medicaid and managed care plans. For health centers already operating on thin margins, those delays translate directly to revenue loss.
The Hidden Costs Add Up Fast
Consider what happens when just one provider's credentialing gets delayed by 60 days:
- Lost billing opportunity: $50,000+ in uncaptured encounters
- Administrative burden: 40+ hours of staff time tracking applications
- Patient access issues: 200+ appointments rescheduled or canceled
- Compliance risk: Potential HRSA findings during site visits
Manual Credentialing vs. HRG-Supported Credentialing
Timeline and Cost Impact Comparison
|
Credentialing Activity |
Manual Process |
HRG-Supported Process |
Time Saved |
Revenue Protected |
|
Initial Provider Credentialing |
90–120 days average |
60–75 days average |
30–45 days |
$25,000–$37,500 per provider |
|
Medicaid Enrollment |
120–180 days (no follow-up) |
75–90 days (active escalation) |
45–90 days |
$37,500–$75,000 per provider |
|
Medicare FQHC Enrollment |
60–90 days |
45–60 days |
15–30 days |
$12,500–$25,000 per provider |
|
Multi-State Licensing |
45–60 days per state |
30–45 days per state |
15 days per state |
$12,500+ per state delay |
|
Payer Application Follow-Up |
Reactive (only when asked) |
Proactive (weekly check-ins) |
Eliminates 2–4 week delays |
$5,000–$10,000 per delay |
|
Recredentialing (Every 2 Years) |
Often missed until billing stops |
Automated 90-day advance alerts |
Prevents billing interruptions |
$50,000+ per lapsed provider |
|
CAQH Attestation Updates |
Manual tracking, frequent lapses |
Automated 30-day reminders |
Prevents 2–3 week gaps |
$4,000–$6,000 per lapse |
|
License Expiration Monitoring |
Spreadsheet tracking, errors common |
Automated system alerts |
Prevents 1–4 week lapses |
$2,500–$10,000 per lapse |
|
HRSA Audit Preparation |
40–80 hours scrambling for files |
Files audit-ready year-round |
40–80 hours saved |
Avoids compliance findings |
|
Provider File Organization |
Disorganized, incomplete files |
Complete, standardized files |
20+ hours per audit |
Reduces audit risk |
|
Payer Contract Negotiations |
Rarely attempted |
Proactive rate reviews |
N/A |
5–15% rate increases |
|
Staff Time Per Provider |
15–25 hours per provider |
2–5 hours oversight only |
10–20 hours saved |
$500–$1,000 per provider |
Annual Cost Impact for a 20-Provider FQHC
|
Category |
Manual Process Cost |
HRG-Supported Cost |
Annual Savings |
|
Lost revenue from credentialing delays (3 new hires/year) |
$75,000–$150,000 |
$0–$25,000 |
$50,000–$125,000 |
|
Denied claims from expired credentials |
$25,000–$50,000 |
$2,000–$5,000 |
$20,000–$45,000 |
|
Staff time managing credentialing (salary + benefits) |
$60,000–$90,000 |
$15,000–$30,000 |
$45,000–$60,000 |
|
HRSA audit preparation scramble |
$10,000–$20,000 |
$0 (always ready) |
$10,000–$20,000 |
|
Missed payer rate negotiation opportunities |
$50,000–$100,000 |
$0 (proactive negotiations) |
$50,000–$100,000 |
|
TOTAL ANNUAL IMPACT |
$220,000–$410,000 |
$17,000–$60,000 |
$175,000–$350,000 |
Key Takeaway
For every $1 invested in professional credentialing support, health centers typically save $3–$6 in protected revenue and reduced administrative costs.
The 4 Credentialing Bottlenecks Crushing Health Center Revenue
Medicaid and MCO Enrollment Takes Forever
State Medicaid agencies and managed care plans have the longest processing times in the industry. Without dedicated follow-up, applications sit untouched for months.
What health centers face:
- 90–180 day wait times for Medicaid approvals
- No visibility into application status
- Zero leverage to escalate or expedite
- Different requirements across every state plan
Recredentialing Deadlines Sneak Up on You
Providers must be recredentialed every two years minimum to stay HRSA-compliant. Miss a deadline, and billing stops immediately.
What health centers face:
- Tracking expirations across dozens of providers manually
- CAQH attestations expiring every 120 days
- License renewals in multiple states
- No automated alerts when deadlines approach
HRSA Site Visits Expose Credentialing Gaps
HRSA Operational Site Visits happen every three years, and credentialing files are always reviewed. Incomplete documentation can result in conditions on your award or worse.
What health centers face:
- Missing primary source verifications
- Incomplete privileging documentation
- Outdated policies that don't match actual practices
- No audit-ready file system
Payer Contract Changes Happen Without Warning
Payers merge, change requirements, update fee schedules, and modify network participation rules constantly. Most health centers only find out when claims start getting denied.
What health centers face:
- Unexpected claim denials from contract changes
- No proactive communication from payers
- Lost revenue from outdated fee schedules
- No bandwidth to negotiate better rates
HOW HRG'S HEALTH CENTER CREDENTIALING SERVICES WORK
Healthcare Revenue Group doesn't just fill out applications. We become your dedicated credentialing department—handling everything from initial enrollment to HRSA audit preparation.
Complete Credentialing Management
Initial credentialing for all provider types:
- Physicians, NPs, PAs, dentists, behavioral health clinicians
- Primary source verification of licenses, DEA, CDS, certifications
- CAQH profile setup and maintenance
- NPDB queries and background checks
- Hospital privileges coordination
Ongoing monitoring and recredentialing:
- Automated tracking of all license and certification expirations
- Proactive recredentialing submissions every two years
- CAQH attestation management every 120 days
- Continuous compliance monitoring
Medicaid and Payer Enrollment Expertise
State Medicaid enrollment:
- Applications to state Medicaid agencies
- PPS encounter rate negotiations
- Site-specific enrollment for multi-location health centers
- Weekly status tracking and payer escalation
Medicare and Medicare Advantage:
- CMS Form 855A submission and FQHC PTAN setup
- PPS billing code configuration
- MA plan contract updates for FQHC recognition
- Wrap-around payment coordination
Commercial carrier contracting:
- Contract updates to reflect FQHC facility type
- Fee schedule negotiations and rate increases
- Network participation analysis
- Appeals for denied rate change requests
HRSA Compliance and Audit Readiness
Policy development and maintenance:
- Written credentialing and privileging policies
- Annual policy reviews aligned with HRSA's 19 Program Requirements
- Appeals and temporary privilege procedures
- Documentation standards for site visits
Audit-ready file preparation:
- Complete provider files with all required verifications
- Organized privileging forms matching provider roles
- Reappointment logs and committee documentation
- Monthly compliance reports for leadership review
Our comprehensive credentialing and contracting services cover every aspect of provider enrollment and payer management.
Why Health Centers Choose HRG for Credentialing
26 Years of FQHC Experience
We've worked exclusively with health centers, medical practices, and specialty providers since 1999. We know Medicaid, we know HRSA compliance, and we know the unique challenges FQHCs face.
100% U.S.-Based Compliance Professionals
Every credentialing specialist on our team is based in the United States, trained in HRSA requirements, and certified in healthcare compliance. No overseas contractors. No language barriers. No compliance risks.
Real-Time Tracking and Transparency
We work directly in your systems—no separate dashboards or PDF reports to chase down. You get real-time visibility into every application, with weekly or monthly check-ins on progress.
No Long-Term Contracts
Unlike other credentialing vendors, we don't lock you into multi-year agreements. You pay for the services you need, with the flexibility to scale up or down as your health center grows.
Proven Results
"They helped us credential 62 providers, prepped for FQHC and HRSA reviews and audits—flawless execution and on-time enrollments."
— FQHC Operations Director, University
"We finally understand our payer contracts and are actually getting paid properly."
— Multi-specialty Clinic, New Jersey
Most health centers we support see measurable improvement within 30 days—especially with Medicaid onboarding timelines and payer follow-up.
How Our Credentialing and Contracting Services Support Your Practice
What You Get When You Partner With HRG
Faster Provider Onboarding
New hires start seeing patients weeks faster with dedicated payer escalation and application tracking. No more "we're still waiting to hear back" delays.
Reduced Claim Denials
Proper credentialing means fewer denials, cleaner claims, and faster payments. Our clients typically see denial rates drop by 15–30% within the first quarter.
HRSA Audit Confidence
Walk into your next Operational Site Visit with complete, organized, audit-ready files. Our compliance team ensures every provider file meets HRSA standards year-round.
Protected Revenue
Every provider stays billing-ready with automated monitoring, proactive recredentialing, and continuous payer communication. No gaps. No surprises. No lost revenue.
Time Back for Your Team
Your staff stops chasing paperwork and starts focusing on patient care. We handle the administrative burden so your team can do what they do best.
Specialized Credentialing for Every FQHC Service Line
Not all credentialing is the same. Every specialty comes with unique requirements, and a one-size-fits-all approach causes delays and denials.
Behavioral Health Credentialing
Therapists, counselors, psychiatrists, and substance use providers require different privileging structures, payer codes, and telehealth authorizations. We ensure every behavioral health provider is properly recognized and reimbursed across all payers.
Learn how we help with complex behavioral health billing.
Primary Care and Internal Medicine
Family practitioners, internists, and pediatricians face high-volume credentialing with multiple payer networks. We manage the entire enrollment process across Medicaid, Medicare, and commercial plans.
Dental Services
Dentists, dental hygienists, and oral surgeons need specialty-specific privileging and payer enrollment. We handle the nuances of dental credentialing so your oral health team stays revenue-ready.
Specialty Services
Whether you offer podiatry, dermatology, cardiology, or other specialty care, our team understands the procedure-based billing, scope-of-practice definitions, and complex payer rules that come with each discipline.
Frequently Asked Questions About Health Center Credentialing
How long does credentialing take with HRG?
Timelines depend on payers and state requirements, but our proactive follow-up and escalation typically reduce credentialing time by 30–50% compared to managing it internally.
Do you work with multi-site health centers?
Yes. We manage credentialing across multiple locations, service lines, and provider types. Many of our clients operate 10+ sites across multiple states.
Can HRG help with HRSA site visit preparation?
Absolutely. We provide audit-ready files, policy reviews, and compliance documentation that meet HRSA's Operational Site Visit requirements. Many clients use our services specifically to prepare for upcoming site visits.
What if we already have internal credentialing staff?
We work alongside your team, not replace them. Many health centers use HRG to handle overflow, manage complex Medicaid enrollments, or provide specialized expertise during growth periods.
Do you offer credentialing only, or do you provide billing support too?
We offer both. Many FQHCs partner with us for comprehensive revenue cycle management that includes credentialing, contracting, billing, and A/R management—all working inside your EHR.
How much do your credentialing services cost?
Pricing depends on the number of providers, service lines, and complexity of your credentialing needs. We offer flexible, pay-for-hours-used pricing with no long-term contracts. Contact us for a custom quote.
STOP LOSING REVENUE TO CREDENTIALING DELAYS
Every day you wait is another day of lost Medicaid billing, delayed patient access, and mounting compliance risk.
Healthcare Revenue Group has the FQHC expertise, Medicaid knowledge, and payer relationships to get your providers credentialed faster—and keep them compliant for the long term.
No long-term contracts. No hidden fees. Just results.