How we work
The work, in the order you live it. And where it stands, every Friday.
This page follows an engagement from your first message to each payer's effective date, and into billing, where the claims go out and the money comes back. It also covers patient data, how we are paid, and what nobody can promise you.
Free, and no patient data.
You write or call, and the people doing the work answer.
Send the request form or call us. The form asks what the practice needs and which payers matter. It never asks about patients.
The free review is a phone call worked from a one-page checklist. We look at the practice as payers see it: who knows the practice and each provider, whether each one has an NPI and a CAQH profile, and which plans your patients carry. If the practice already bills, we look at what goes out and what comes back.
- What it costs
- Nothing, and it commits you to nothing.
- What to have ready
- Your payers, your providers' NPIs, your state, and when you open or when the new provider starts.
- What you leave with
- A written plan: every application we would file, in order, with its fee. It is yours whether or not you hire us.
After you sign, most of the first week is ours.
The agreement repeats the plan, and enrollment is invoiced once, when you sign. Then the work runs in this order.
One request for your documents
We send one list of what only the practice can supply: licenses, malpractice certificates, ownership details and signatures. We gather the rest.
The records payers read first
We check each provider's NPPES record and set up or update the CAQH profile that most commercial payers pull from. CAQH must be re-attested on a set cycle, so we note when each profile comes due.
Filing, in the order your schedule needs
Medicare goes through PECOS and Medicaid through your state's program. Commercial panels follow in the agreed order, led by the plans most of your patients carry.
The first Friday board
The first Friday after you sign, you get a page listing every application and its status. It comes every Friday until the last payer answers.
Each application is prepared against a written checklist, so every file is checked the same way before it goes.
Six status words, never more.
One page each Friday, with a row for every application.
Each row names the payer, its status, the next action and whose move it is. When the move is yours, the row asks for one specific thing, such as a signature. When a payer goes quiet, we call and write, and the row records what we tried.
- Preparing
- We have what we need and are completing the application.
- Submitted
- Filed. The payer has not started on it yet.
- In review
- The payer is working on it, and we are checking in.
- Needs you
- The payer asked for something only the practice can give.
- Panel closed
- The payer says it is not adding providers. We ask for an exception in writing.
- Effective
- The payer has confirmed an effective date in writing.
One row, followed from Friday to Friday.
An illustration only: a placeholder payer, no real practice and no client record. Only the Fridays where the row changed are shown; the payer sets the pace between them.
Preparing Commercial plan A
The CAQH profile is attested and the application is complete. Next move: ours, to file it.
Submitted The next Friday
Filed, and the payer's reference number is logged on the row. Next move: the payer's. We confirm it was received.
In review A later Friday
A credentialing analyst has the file. We call and write on a set rhythm, and each attempt is recorded on the row.
Needs you When the payer asks
The payer wants a signed attestation page. The row names that one page and nothing else. Once it is back, the move is ours again.
Effective The Friday it lands
The payer confirms a date in writing. The date goes on the row and into your enrollment file, with a page on what to bill under it.
The effective-date column stays blank until a payer commits to one in writing. An illustration of the board, with placeholder payers such as Commercial plan A and no real practice, is on the home page.
The payer sets the date. We send what to bill under it.
An effective date is the day a payer starts paying a provider's claims. Visits before it carry no guarantee of payment, so a new provider's first schedule should follow their enrollment.
When a payer confirms, you receive its letter and a page from us on billing that payer: which provider and location the enrollment covers, how claims should go out, and what to check on the first few.
When the last payer answers, you keep the enrollment file, with every application, reference number and letter in it. The next provider who joins starts from that file.
Once a payer says yes, we run the revenue cycle.
Billing is the other half of the work, and we run all of it: benefits and eligibility before the visit, authorizations, claim build and follow-up, payment posting and reconciliation, denials and appeals, and underpayment detection against what each payer agreed to pay.
The report tells you which payer pays late, which denies, and which pays less than it owes, with the reason each time. That is what we mean by payer intelligence.
A practice can start with enrollment, with billing, or with both. The enrollment file is complete either way. For billing, we read your payer mix and claim volume, and the price goes into the agreement.
Security and compliance, in plain words.
Enrollment runs on practice information, never patient records.
Enrollment needs details about the practice and its providers, such as licenses, NPIs, ownership and malpractice coverage. It needs nothing about any patient.
Keep patient names, dates of birth, member IDs and claims out of the form and out of email. If later work involves patient information, such as billing, we sign a business associate agreement with your practice before any of it changes hands.
Provider documents go only where an application sends them: CAQH, PECOS, your state's Medicaid program and the payers you chose. The security and compliance page names the services that carry your messages.
Printed fees, settled before any work starts.
| Item | What it covers | Fee |
|---|---|---|
| Organization application | One per payer, for the practice itself. | $350 |
| Practitioner application | One per provider, per payer. | $250 |
| CAQH setup | For each provider whose profile needs setting up. | $150 |
| Solo practice | One application per payer, with no practitioner fee. | $350per payer |
| Service Line Made Billable | One written answer for one service. | $2,500 |
| Billing and revenue cycle | Claims, posting, denials, appeals, underpayments and reporting. Set from your numbers, in the agreement. | By agreement |
Enrollment is priced per application, because a practice that cannot bill yet collects nothing. Billing is priced from the practice's own payer mix and volume. Both are in writing before any work starts.
Two decisions belong to the payer.
Medicare usually answers first. Medicaid timing depends on the state, and commercial plans take months. What we control is the file. A complete one gives the payer no reason to send it back.
A closed panel is not always final. We ask for an exception in writing, and our note on closed panels covers the other routes.
What owners ask about the day-to-day.
Who will I be dealing with?
One point of contact runs the review and stays with the practice. The same firm keeps the Friday board current, runs the billing and writes every Service Line answer.
We are already enrolled. Can you add one new provider?
Yes. With the practice already enrolled, no organization application is needed. Each payer takes one practitioner application at $250, plus $150 if the provider needs a CAQH profile set up.
We have more than one location. Does that change the work?
It adds to it. Each payer has to hold every address where the practice sees its members, and each clinician has to be linked to the sites where they work. The plan from the review lists every location against every payer, so nothing is filed for one site and missed at another.
What if our address, tax ID or an NPI changes partway through?
Tell us as early as you can, ideally before it happens. A change like that reaches every application still open. We update the NPPES record, the CAQH profile and each pending file, so no payer approves details the practice no longer uses.
A provider is leaving before their applications finish. What happens?
We withdraw that provider's open applications with each payer, so no plan links them to the practice after they go. The rest of the Sprint carries on, and the Friday board shows each withdrawal.
What does the Friday board show, and what does it leave out?
Every application, its status, the next action and whose move it is. It leaves out guesses: no expected date appears until a payer commits to one in writing. Once billing runs, the same page adds claims paid, denied and underpaid.
Who owns the enrollment file?
The practice. Each application, the payer's reference number, every letter and each effective date go into a file that is yours, whether or not you keep working with us.
Take the review first, then decide.
Send a few facts about the practice and its payers. You see the plan and every fee before anything is signed.
We get back to you as quickly as possible.