Provider Credentialing 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. This page is for practice owners and administrators who have been through that. We will name where credentialing stalls, what the delay costs, and what it takes to fix it.
Credentialed, But the Claims Still Deny
The pattern shows up the same way every time. A provider gets credentialed. The approval letter arrives. Then the claims come back denied anyway.
The denial code reads M115. On paper it looks like a credentialing problem. It usually is not. Your provider is credentialed, but not yet linked to your group with that payer.
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Step 1
Credentialed
Verifies the provider.
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→ |
Step 2
Linked to your group
Ties the provider to your group contract and tax ID.
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Credentialing verifies the provider. Group enrollment ties that provider to your group contract and tax ID. Two separate jobs, two separate clocks.
So you call the payer and hear one line. The provider is still not loaded. Weeks pass. Claims pile up. The revenue sits frozen while each team points at another.
This is the gap that burns practices most often. A full breakdown of the M115 denial code explains why credentialed providers still get denied. It also walks through how to clear it.
What Getting Paneled Actually 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.
The table below shows those timelines two ways. One column is the application left to drift. The other is the same application worked every week.
| 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% approval record |
| Your staff time per provider | 15 to 25 hours | 2 to 5 hours of oversight |
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, wants a fresh attestation every 120 days. Miss it and the profile goes stale. A stale profile quietly breaks the enrollment and billing that depend on it.
Most practices find out the hard way. A payer rejects a clean claim for a credentialing reason, and the hunt begins.
We maintain your provider profiles every 30 days, not on the 120-day cycle. Since we switched to 30-day maintenance, our clients see roughly 90 percent fewer A/R issues. 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 committee 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. 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. That record covers new privileges and reappointments alike. You can see how this works across states in our multi-state specialty credentialing case study.
PECOS, Medicaid, and the Enrollment Maze
Medicare enrollment runs through PECOS. Each state Medicaid program adds its own forms and its own rules. Managed care plans layer on more.
One missed field can send the whole application back to the start. That is another 30 days gone, and the provider is still not billing.
HRG manages Medicare, Medicaid, and MCO enrollment applications. We submit, track, and follow up through to the effective date. You are not left wondering 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 actually 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 no, we file appeals and re-engage later.
Final rates rest with the payer. The point is that someone is finally pushing for you.
Priced by the Hour, Not by the Panel
Most credentialing vendors bill a flat fee per application or a monthly retainer. You pay whether the application moves or not.
HRG works differently. We bill hourly, for time actually used. You review every invoice before we charge it.
The contract is one page, month to month, with no minimums and no auto-renewal. You can set a monthly hours budget, and we flag it before we reach it. If credentialing is not moving, you are never locked in.
What You Get When HRG Manages Your Credentialing and Contracting
| ✓ | Initial credentialing and recredentialing, tracked so no deadline slips past you |
| ✓ | CAQH, now 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. That expertise is backed by over 26 years of this work.
Get Your Providers Billable Faster
If new providers are sitting unbillable, the clock is the enemy. Every week of delay is a week of revenue you will not get back.
Credentialing and contracting route to Mellissa Harmon at HRG. 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.