Provider Credentialing and Payer Contracting Services That Get You Paid
You added a provider two months ago. Good provider credentialing services should have that provider billing by now. Instead the claims keep bouncing, and nobody can tell you why.
Healthcare credentialing services are the ongoing work of getting each provider verified, enrolled with every payer, linked to the right group, and through privileging at each facility, then carrying each provider through the first paid claim and keeping all of it current. Each of those approvals runs on its own clock. A provider can clear one payer and still sit unbillable with the next.
The same clocks run for every provider a hospital or health system privileges, and for health centers, skilled nursing facilities, urgent care groups, and allied clinicians from nurse practitioners to therapists and audiologists. Most of those stalls trace to a handful of specific steps. Once you know which one you are stuck on, you know who has to move next.
Credentialed, But the Claims Still Deny
The pattern shows up the same way every time. A payer approves the provider and the letter arrives. Then the claims come back denied anyway.
The denial code reads M115. On paper it looks like a credentialing problem, and it usually is not. Your provider is credentialed but not yet linked to your group with that payer.
| Step | What it does |
|---|---|
| Step 1: Credentialed | Verifies the provider. |
| Step 2: Linked to your group | Ties the provider to your group contract and tax ID. |
Those are two separate jobs on two separate clocks, and finishing the first does not start the second. So you call the payer and hear the same line every time: the provider is not loaded yet. Weeks pass while claims pile up. The revenue sits frozen as each side points at the other.
This is the gap that burns practices most often. Our full breakdown of the M115 denial code explains why payers keep denying claims from credentialed providers and how to clear it.
What Getting Paneled Takes, Payer by Payer
Every payer runs its own clock. None of them run fast. Left alone, a commercial application can sit for months while nobody pushes it. Medicaid runs longer still. Between an application left to drift and one worked every week, the gap runs roughly 30 to 45 days on commercial payers and up to three months on Medicaid.
| Process | Without follow-up | HRG-supported |
|---|---|---|
| Commercial payer credentialing | 90 to 120 days | 60 to 75 days |
| Medicaid and MCO enrollment | 120 to 180 days | 75 to 90 days |
| Hospital privileges | Committee-driven, varies by facility | Tracked weekly, 100 percent approval record |
The difference is not magic. It is someone working the payer every week instead of waiting for a letter.
The Hidden Cost of a Stalled DataSpring Profile
CAQH, now DataSpring, requires a fresh attestation every 120 days. Miss one and the profile goes stale, which quietly breaks the enrollment and billing that depend on it. Payers pull from that profile whenever they check a provider, so a license renewal or a new practice address that sits unrecorded for months travels straight into their files. Most practices find out when a payer rejects a clean claim for a credentialing reason and the hunt begins.
We maintain your provider profiles every 30 days instead of on the 120-day cycle. Since moving to 30-day maintenance, HRG has seen roughly 90 percent fewer A/R issues from outdated provider data. The lapse never gets the chance to start.
A 100 Percent Hospital Privilege Approval Record
New providers who need hospital privileges wait on a committee that meets on its own schedule, not yours. Surgical revenue stalls until the privileges clear.
We manage the privilege application and every reappointment. The committee still decides, and the hospital grants the privileges. What we bring is a clean, complete file and steady follow-up.
HRG holds a 100 percent approval record on the hospital privilege applications it has managed, new privileges and reappointments alike. Our multi-state specialty credentialing case study shows how that works across state lines.
PECOS, Medicaid, and the Enrollment Maze
Medicare enrollment runs through PECOS. Each state Medicaid program adds its own forms and rules, and managed care plans layer on more. One missed field can send the whole application back to the start, which costs another 30 days while the provider still is not billing.
HRG manages Medicare, Medicaid and MCO enrollment applications, submitting, tracking and following up through to the effective date. On Medicare, we complete in roughly 60 days an application that can take a self-managing practice over a year of corrections and resubmissions. You always know where an application sits.
Contracting That Works in Your Favor
Getting in-network is only half the job. The rate on that contract decides what the work is worth. Too many practices sign the first number a payer offers.
HRG negotiates directly with payers on your behalf. We review the fee schedule and build the payer-facing case. When a payer resists a blanket increase, we pursue carved-out rates for high-value CPT codes. If the answer is still no, we file appeals and re-engage later. The entire Provider Services team is HCPro-certified in provider enrollment, and three team members have completed MGMA's Payer Contracting Certificate program.
Final rates rest with the payer. What changes is that someone is finally pushing for you.
"From the contracting piece, paperwork and calls but really to pushing back to get us the best rates, I could never thank you enough."
Angela Sombrio, Revenue Cycle Manager, Ohio Vein
Priced by the Hour, Not by the Panel
Credentialing runs on a one-page agreement you can leave in any month. Four terms keep the spend in your hands.
- One-page contract, month to month. No minimum term and no auto-renewal, so you are never locked in.
- Hourly billing for the time used. Not a percentage of collections and not a flat retainer.
- Invoices you review before we charge. You see the hours before the money moves.
- A monthly hours budget you set. We flag it before we reach it, so the spend stays your decision.
That pricing covers credentialing only. Billing and revenue cycle management run on their own longer-term agreement, scoped to your practice during onboarding.
Book a credentialing assessment with Mellissa
What You Get When HRG Manages Your Credentialing and Contracting
| ✓ | Initial credentialing and recredentialing, tracked so no deadline slips past you |
| ✓ | DataSpring profiles maintained every 30 days |
| ✓ | Primary source verification of license, education, and board certification |
| ✓ | Medicare, Medicaid, and MCO enrollment managed through to the effective date |
| ✓ | Hospital privilege applications and reappointments, managed end to end |
| ✓ | Direct payer negotiation on your rates, with appeals when a payer says no |
| ✓ | Multi-state licensing for telehealth groups and expanding practices |
| ✓ | Everything handled inside your existing systems, by a 100 percent U.S.-based team |
No separate dashboards, no PDF reports, no offshore handoffs. You keep full visibility inside the systems your team already uses, backed by over 26 years of this work.
Medical Credentialing Services, Questions Answered
Our provider is credentialed but not associated with our practice. Who fixes payer loading?
Healthcare Revenue Group (HRG) fixes it. Our Provider Services team files the group reassignment, confirms the provider is on each payer's roster for your tax ID and locations, and follows up until payer loading is complete. We stay on it through the first paid claim, not just the approval letter. The payer makes the final participation decision.
How long does provider credentialing take?
Commercial credentialing often runs 90 to 120 days without steady follow-up. With HRG working it weekly, most applications land in 60 to 75 days. Medicaid and MCO enrollment take longer on both paths.
My provider is credentialed but the claims still deny. Why?
The provider is most likely credentialed but not linked to your group with that payer. That gap triggers denials like M115. Group enrollment is a separate step, and we manage it alongside credentialing.
What happens if our DataSpring attestation lapses?
A lapse can stall enrollment and trigger credentialing denials on clean claims. Most lapses start on the 120-day cycle, which is why we maintain profiles every 30 days.
Do you guarantee credentialing approval?
No honest partner can. Payers and hospital committees make the final call. We build complete files and work them hard. HRG holds a 100 percent approval record on the hospital privilege applications it has managed.
Do you use CredentialStream or a separate platform?
Neither. We work directly inside your existing systems and payer portals, so your team has no new software to learn and no separate dashboard to check.
Is there a long-term contract?
No. Credentialing runs on a one-page agreement, month to month, with no minimums. You pay hourly for time used and review every invoice before we charge it.
Get Your Providers Billable Faster
If new providers are sitting unbillable, the clock is the enemy. Every week of delay is revenue you will not get back. When you are bringing on a provider who has not started billing yet, a new provider revenue ramp planner budgets the 90 to 120 day gap before that provider generates revenue.
Book time with Mellissa Harmon, who leads HRG's Provider Services team. Bring your stuck providers, your closed panels or your next new hire. There is no pitch and no pressure, just a straight read on your timeline.
Book a credentialing assessment with MellissaOr call 913-937-2995
"In an area where delays and administrative obstacles can significantly impact a practice's operations and revenue, Mellissa has been a trusted partner who delivers on her commitments and advocates tirelessly on behalf of her clients."
Dr. Allen Silvey, MedCorps Asthma and Pulmonary Specialists