Practice service · every specialty

Credentialed, enrolled, and kept current.

A physician who is not enrolled with a payer cannot bill that payer, and the enrollment clock runs in months, not weeks. Start late and the cost is not an administrative headache — it is a clinician seeing patients whose work nobody can invoice.

Start an enrollment How enrollment runs

Applications chased weeklyCAQH and PECOS kept currentRevalidation tracked before it lapses

How long enrollment takes

From application submitted to an effective date you can bill against.

Typical range, submission to approval90–180 days

Payers taking this long for an effective dateup to 100 days

Added delay when the application is incomplete+30–45 days

Sources: MGMA, 2021 (90–180 days); MGMA Stat, 2021 (effective dates); CMS, 2017 (incomplete-application delay).

How it runs

Complete on the first pass

Almost every delay in credentialing is self-inflicted: a form submitted with a gap in it, then queued again behind everyone else.

One provider, one payer

Per enrollment

Step 1Documents gatheredLicenses, DEA, board certification, malpractice, work history, references.

Step 2CAQH & PECOS builtProfile completed and attested, because most payers pull from it.

Step 3Application submittedComplete on the first pass — the single biggest cause of delay is a missing field.

Step 4Primary source verificationThe payer verifies with the issuing body. We answer their questions.

Step 5Chased weeklyEvery open application worked on a schedule, with a named contact at the payer.

DoneEffective date on fileApproval, effective date recorded, and the revalidation clock started.

The effective date is the number that matters. We ask for it in writing and tell you which claims can be submitted retroactively and which cannot, so nothing is billed that will only come back as a denial.

Where it goes wrong

Delays are clerical, not clinical

Published figures from CMS and MGMA, not OnPoint RCM results.

Applications delayed for missing information

Paper applications triggering a request for more information>50%

Web applications triggering the same~25%

All applications that end up delayed30–35%

A third of Medicare enrollment applications are held up, and the cause is almost always an incomplete submission rather than a substantive problem.

Source: CMS, 2017 — Medicare provider enrollment.

The maintenance calendar

Medicare revalidation

5 yrs

CAQH re-attestation

120 days

Credentialing is not a one-off project. A lapsed attestation quietly stops claims paying, and nobody notices until the remittance arrives.

Sources: CMS (every 5 years; 3 for DMEPOS suppliers); CAQH ProView (every 120 days, 180 in Illinois).

Why practices feel thisMGMA Stat found in 2021 that 54% of practices reported credentialing-related denials increasing over the prior year. That is a directional survey finding rather than a denial rate, and we quote it as such — but it matches what we see: the denials are rarely clinical, and almost always a date, a roster or an attestation that quietly went stale.

Division of labor

What we do, and what stays with you

OnPoint RCM does

Gathers and verifies every required document
Builds and maintains CAQH and PECOS profiles
Submits applications complete on the first pass
Answers payer verification requests
Chases every open application weekly
Records effective dates and what can be billed retroactively
Tracks revalidation and re-attestation before they lapse

Your practice keeps

Which payers you want to be in network with
Contract terms and fee schedule negotiation
The credentials themselves — licenses, DEA, certification
Final signature on every application

Questions we get

Before you ask

When should we start for a new hire?

The day the contract is signed, and ideally 120 days before their start date. Enrollment commonly runs 90 to 180 days, so a clinician who starts before it completes is seeing patients you may not be able to bill for.

Can we bill retroactively once approval comes through?

Sometimes, and it depends entirely on the payer and the effective date they grant. Medicare has its own rules; commercial payers vary and some allow nothing. We get the effective date in writing and tell you which claims are safe.

What happens if a revalidation is missed?

Billing privileges can be deactivated and claims stop paying, usually discovered from a remittance rather than a warning. That is the whole argument for tracking the calendar rather than reacting to it.

Do you negotiate our contracts?

No. Getting you enrolled and keeping you enrolled is our job; what you get paid under the contract is a separate negotiation, and we will tell you plainly when a rate looks out of line.

See what your practice is leaving on the table

A 30-minute call. Tell us roughly how many Medicare patients you see, which EMR you use and what you already run in-house. We come back with which programs your patients qualify for, what each one would take to run, and what it is likely to be worth.

Call (636) 634-1229

(636) 634-1229Mon–Fri, 8am–6pm CT

info@onpointrcm.comWe reply the same business day

201 Clarkson Executive ParkEllisville, MO 63011

Request a practice review

Same-day reply. Nothing is billed and no patient is enrolled from this form — it starts a conversation, nothing more.

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