| Payer | What it publishes | The clock starts at |
|---|---|---|
| Medicare, online through PECOS | CMS holds its contractors to finishing 95% of applications within 15 calendar days, or within 50 when the contractor has to ask for more information or make a site visit. | Receipt of the application |
| Texas Medicaid | Up to 60 business days. The agency's current notice says most applications are taking 90 to 120 days. | All required information received |
| California Medi-Cal | A legal maximum of 90 days for physicians and 180 days for other provider types. | Application received |
| Florida Medicaid | 60 days or less. | Submission or a complete application (the agency's page says both) |
| UnitedHealthcare | Credentialing generally takes up to 45 calendar days or more. Once it is approved and the signed contract is back, loading the contract can take up to 60 more days. | A completed application |
| Cigna | Typically 45 to 60 days, then about 10 business days to load you into its directories and claim systems. | Not stated |
| Anthem (California) | Typically 45 days. | A completed CAQH application |
| Humana | Should be completed within 30 calendar days, or as state or federal rules require. | A complete application |
| Blue Cross and Blue Shield of Kansas City | Primary source verification within 45 to 60 days. Claims filed before credentialing finishes are paid as out-of-network. | A completed application |
Payer Enrollment Sprint
We file your applications with every payer you choose and follow up until each one approves you with an effective date, or says no in writing.
The Sprint enrolls a new practice, a new provider or a new location with Medicare, your state's Medicaid program and the commercial plans your patients carry. Each application has its own fee, paid in full when you sign. Each application has a written status and next action.
Enrollment never needs a patient record.
- Health Revenue Intelligence, LLC
- A business associate agreement before any patient record
- Printed fees
- Status, next action and owner
iWhat is included
What the Sprint includes.
NPPES check
We read the NPI record for the practice and each provider. Payers check every application against that record, so an old address there is corrected first.
CAQH profile
Built or repaired for each provider, attested, and released to your plans. Most commercial payers pull from it instead of asking you again.
Medicare, through PECOS
The practice, each practitioner, and the link that sends their Medicare payments to the practice.
State Medicaid
Filed on your state's portal, under its rules, if you take Medicaid.
Commercial panels
Group and practitioner applications for each plan you name.
The follow-up
Calls and letters to each payer until it answers, each one logged with a name and a reference.
Your work status
One row per application, with the next move and whose it is.
The enrollment file
Yours to keep: every application as filed, each effective-date letter, when the next CAQH profile attestation falls due, and a page per payer on what to bill it.
iiThe order we file in
A fixed sequence, because later forms lean on earlier ones.
Filed out of order, an application waits on a number nobody has yet.
Confirm the payer list
We check where the practice and each provider stand with every payer.
The records
NPPES corrected where it needs it. CAQH profiles built, attested and released.
Medicare
The practice through PECOS, then each practitioner, linked back to it.
Medicaid
Your state's program, where you take it.
Commercial plans
The plans you named, starting with the ones most of your patients carry.
The effective date
Each payer's date, in writing, filed with the page on what to bill that payer.
iiiWhat we need from you
A checklist to start. Specific requests as work progresses.
We ask for the documents needed to begin and reuse information you have supplied where it meets the payer's requirements. If a payer needs an updated document or signature, we identify what is missing and who needs to provide it.
Before you gather anything, the free enrollment snapshot shows what NPPES and Medicare already hold for a provider's NPI, and what to check first.
- For the practice
- Legal name, tax ID, group NPI, every service address, the owners, and a bank letter for direct deposit.
- For each provider
- Individual NPI, state licenses, DEA registration if they prescribe controlled substances, board certification where it applies, a malpractice certificate and a CV.
- For the payer list
- The plans you want, ranked by how many patients carry them. A rough list is fine.
ivThe fees
Priced per application, because every payer is its own piece of work.
A solo practice owned by its only clinician pays one fee per payer, even where that payer needs more than one form.
| Item | What it covers | Fee |
|---|---|---|
| Organization application | The practice, with one payer.A solo practice files only this one, once per payer. | $450 |
| Practitioner application | One provider, with one payer, linked to the practice.$325 each for 11 to 25 applications in one order; $300 each for 26 or more. The block rate covers every practitioner application in the order. | $350 |
| CAQH setup | One provider's profile, built or repaired, and attested. | $300 |
| Credential maintenance | Re-credentialing, re-attestation, expiring documents and roster changes with each plan, from the first effective date. | $200per enrolled provider per month, $600 a month minimum |
| The practice | What gets filed | Sprint fee |
|---|---|---|
| A solo practice, four payers | Four applications at $450 and one CAQH setup.$525 per payer. | $2,100 |
| One new provider, five payers, practice already enrolled | Five practitioner applications and one CAQH setup. No organization application. | $2,050 |
| Two providers, five payers | Five organization applications, ten practitioner applications and two CAQH setups. | $6,350 |
| Five providers, six payers | Six organization applications, thirty practitioner applications and five CAQH setups. | $13,200 |
Billing and revenue cycle and the written answer on a new service are separate engagements. The Sprint ends when every payer on your list has given a date or a final answer.
vWhen a payer stalls
We answer each request a payer sends and log it on your Work status.
When an application goes quiet, we call and write, and log who we spoke with. If that does not move it, we go to the payer's provider relations staff and the note says so.
A closed panel means the plan says it is not adding providers where you practice. We file an exception request that makes the practice's case in writing. If the plan reopens or refuses again, we tell you that week. More in the field note on closed panels.
Enrollment progress
| Payer | Status | Next action | Expected effective date |
|---|---|---|---|
| Commercial plan A | Panel closed | UsException request filed with the practice's case. | None until the panel answers |
| Commercial plan B | Needs you | YouSign the attestation page we marked. We send it on as soon as it is back. | Not set yet |
viTypical payer times
What each payer publishes about its own processing time.
Each clock starts only when the payer has what it asked for. Contracting and loading into the payer's claim system often follow credentialing.
viiQuestions
Common questions before signing.
Should we enroll as a group or as individual providers?
Usually both. The organization application puts the practice on file under its tax ID. Each practitioner application adds one clinician and links them to the practice. A solo practice owned by its only clinician pays one $450 fee per payer, covering every form that payer needs for the owner and the practice.
How long does credentialing and payer enrollment take?
Published standards run from about a month to two months or more for commercial credentialing, often with contract loading after it, and state Medicaid programs publish anywhere from two months up to a legal maximum of six. The payers' own numbers. We follow each application until the payer answers and tell you as soon as one commits to an effective date in writing.
Can a new provider see patients before they are enrolled?
Yes. The risk is billing a payer under their name before its effective date. Medicare's incident-to rule sometimes lets a supervised visit bill under an enrolled physician, on narrow conditions. We write down, payer by payer, what you can bill meanwhile.
Can a single-case agreement cover us while we wait?
Sometimes, for one patient. While credentialing is pending, a payer may pay for that patient's care as if you were in network. It is the payer's call, usually tied to a gap in its network or to continuity of care, and it does not put the practice in the network.
What about re-credentialing later?
Payers re-check a provider's credentials on their own cycle, and the CAQH profile has to be re-attested on a set cycle. Your enrollment file shows when the next attestation falls due, so nothing lapses without warning. Keeping enrollments current after the Sprint is outside its fee. CAQH upkeep, re-credentialing and Medicare revalidation are available on their own, priced in writing first.
What happens when a payer says no?
You get the payer's reason in writing and what is still open: a corrected application, an appeal, or a new filing when the panel reopens. The letter goes into your file.
Do we have to hire you for billing afterward?
No. The Sprint stands on its own and the enrollment file is yours. Billing is a separate agreement if you want it.
Talk to HRI Med
Bring your payer list, even a rough one.
Tell us what is already enrolled and what needs filing. We confirm the applications required and their fees in your proposal.
Mark any payer that has already sent back an application or asked for more.