Problems We Fix
Adding Providers To Your Group?
Adding a provider changes more than the schedule. Before their first claim goes out, the provider needs a signed agreement, a pay plan, payer enrollments under your contracts, EHR access and a staff that knows who does what. The payer piece is New Provider Credentialing. That’s $3,000 to credential one provider with five commercial payers your group already contracts with, or $600 per payer if you need fewer.
Build My Price See Package DetailsNew Provider Credentialing covers one provider joining a practice that already holds executed commercial payer contracts, for up to five payers. Adding more than one provider? Group discounts apply automatically at checkout.
Give Every Part Of The Start Date A Named Owner
- Working relationship. Settle the role, employee or contractor status, the agreement and the pay plan with your attorney and accountant.
- Payers. Give each payer its own line for every provider, with the location, the application date and the written effective date.
- Systems. The provider needs their own EHR login, scheduling rules, note templates and billing record before day one, plus training on all of it.
- Compensation handoff. Decide which report the pay is calculated from, who reviews it and when, and who sends the approved numbers to payroll or the bookkeeper.
- First month review. Check completed visits against claims, missing notes, rejections, payer responses and posted payments, and ask the staff what tripped them up.
A signed agreement doesn’t mean a provider can bill every plan, and an approval email doesn’t prove the billing record was loaded right. Watch the first claims closely until each payer is actually paying the way it should.
Use the solo to group practice guide for the full planning checklist. For worker classification, use the IRS guidance on employees and independent contractors.
The Provider-Launch Operations That Prevent It
Credentialing Lead Time Built Into The Offer
Enrollment paperwork starts the day the contract is signed, not the provider’s first day. With a 60 to 120 day payer timeline, a start date 30 days out guarantees a stretch where the provider can’t bill. We build the launch calendar backward from realistic effective dates. The offer conversation sets that expectation with the provider up front.
Payer Participation Planning
Which panels does this provider actually need, in what order? The plans that fill their intended caseload come first; marginal panels can trail. If a panel is closed or slow, the plan says so before the schedule is built and the group decides deliberately how to use the provider until each payer turns on.
Roster, Linkage, And Directory Updates
At many payers, linking a provider to your group contract, adding them to the roster and getting them into the directory are separate steps from individual credentialing. They’re also the steps people skip most. A provider can be individually credentialed and still get denied because nobody linked them to your group’s contract. We track each payer’s linkage confirmation as its own line item. We don’t assume it.
Ramp Scheduling Gated On Payer Readiness
The schedule opens payer-by-payer as effective dates confirm: the new provider’s template starts with the plans that are live and the visit types that are billable, and expands as each enrollment lands. The front desk works from a simple readiness grid that shows which payers are live for this provider today, so booking errors stop at scheduling.
Incident-To And Supervised Billing: Handle With Care
Groups adding PMHNPs or physician assistants often plan to cover the credentialing gap with incident-to or supervised billing. Sometimes that’s legitimate. Often it’s misapplied. Incident-to billing under Medicare has strict requirements (the physician sets the plan of care and stays involved, and a new problem is never incident to), and each commercial payer has its own rules that may look nothing like Medicare’s. Used casually as a credentialing workaround, it creates repayment and compliance exposure that dwarfs the revenue it covered.
We wrote a full breakdown at incident-to billing for PMHNPs. Know each payer’s actual rule, document to it, and never let “we’ll just bill it under the supervising physician” substitute for a real enrollment plan.
What A Managed Provider Add Looks Like
When we run provider launches for a group, each new provider follows the same checklist instead of a scramble. We start enrollment at signature and track every payer on a grid with set follow-up dates. Roster and directory updates get confirmed payer by payer. EHR and system access is ready before day one, note templates match the provider’s billing profile, and the schedule opens up as each payer confirms. You’ll see one status view for every provider in progress.
It’s part of our credentialing work, and of the Operations Partnership when we run the business side with you. For the specific case of bringing a psychiatric nurse practitioner into your group, supervision, scope, and billing model included, see Adding a PMHNP to Your Practice.
Common Questions
How Far Ahead Of A Start Date Should Credentialing Begin?
Ideally 120 to 150 days, which usually means starting enrollment the day the offer is signed, not the day the provider starts. If you have less runway than that, the launch plan should spell out what the provider does during the gap instead of pretending it won’t happen.
Can The New Provider See Patients While Enrollments Are Pending?
For plans where they aren’t effective yet, generally not in a way you can bill, with narrow exceptions that vary by payer and state, such as retroactive effective dates or properly executed supervised-billing arrangements. What works reliably is a schedule that opens payer by payer as effective dates confirm.
What Is Payer Linkage, And Why Did Our Credentialed Provider Still Deny?
At many payers, individual credentialing and attachment to your group contract are separate transactions. A provider can pass credentialing and still get denied as not eligible because the roster linkage never went through. Track each payer’s linkage on its own line.
Is Incident-To Billing A Safe Bridge During Credentialing?
Only when that payer’s requirements are actually met and documented. Medicare’s rules are strict. Commercial payers differ, and using incident-to loosely as a workaround creates audit and repayment exposure. Read our incident-to guide before you rely on it.
Do You Handle The Whole Provider Launch Or Just Credentialing?
Either. Some groups hand us just the enrollments, which is New Provider Credentialing at $3,000 per provider for five payers. Others have us run the whole launch, from roster and directory updates to system access and the payer-by-payer schedule, as part of an Operations Partnership.
What This Looks Like
Check The Contracts You Already Have Before You Add Anyone
Before one practice added its first provider, two of its own payer contracts turned out to be broken. One insurer was denying every claim as out of network, even though its own welcome letter said the practice was in network. An escalation that morning, with the executed contract attached, got it confirmed the same afternoon, and the claims went back for reprocessing. Five months of denials resolved in one business day. A second contract had quietly expired, and nobody would’ve known except for the denial pattern.
Not Sure Which Credentialing Package Fits?
Every credentialing package has a published price and a written scope. Tell us what’s changing in your practice and which payers you need, and we’ll point you to the right one.