Payer Enrollment Sprint
Every payer on your list, filed and then followed. The work ends when each one puts a date 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, and all of them sit on one page each Friday.
Enrollment never needs a patient record.
All of it is inside the fee.
Everything between an empty payer list and the first paid claim.
Until a payer has enrolled the practice and linked each clinician to it, claims to that payer come back unpaid or out of network.
- NPPES check
- We read the NPI record for the practice and each provider. An old address there gets copied into every application after it, so it 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.
- The Friday board
- 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 attestation falls due, and a page per payer on what to bill it.
The same sequence for every practice.
A fixed sequence, because later forms lean on earlier ones.
Later applications often ask for what an earlier one produced. Filed out of order, an application waits on a number nobody has yet.
The review
We check where the practice and each provider stand with every payer, from a one-page checklist.
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.
Asked for once.
One checklist at signing, and nothing asked for twice.
A missing document is the easiest delay to avoid, so we collect everything before the first form goes out and reuse it wherever a payer asks. A later signature comes as one request naming the page.
- 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.
- Never
- Anything about a patient.
Paid in full at signing.
Priced per application, because every payer is its own piece of work.
Each payer runs its own application and sets its own date, so each application carries its own fee. A solo practice owned by its only clinician files one application per payer.
| Item | What it covers | Fee |
|---|---|---|
| Organization application | The practice, with one payer.A solo practice files only this one, once per payer. | $350 |
| Practitioner application | One provider, with one payer, linked to the practice. | $250 |
| CAQH setup | One provider's profile, built or repaired, and attested. | $150 |
| Free billing review | Where each provider stands today. No patient data. | No charge |
| The practice | What gets filed | Sprint fee |
|---|---|---|
| A solo practice, four payers | Four applications at $350 and one CAQH setup.$387.50 per payer. | $1,550 |
| One new provider, five payers, practice already enrolled | Five practitioner applications and one CAQH setup. No organization application. | $1,400 |
| Two providers, five payers | Five organization applications, ten practitioner applications and two CAQH setups. | $4,550 |
| Five providers, six payers | Six organization applications, thirty practitioner applications and five CAQH setups. | $10,350 |
Our fees are printed here, and the total is invoiced once, at signing.
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.
Every contact is logged.
A payer decides when. Our side of the file never sits unanswered.
No one outside a payer controls its pace, so you will not find a number of days here. What we control is the file. It goes in complete, and every payer question gets a full answer.
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. Some panels reopen without warning. Some say no again. Either way you hear it from us the week we hear it. More in the field note on closed panels.
Two rows from a Friday board
| 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 |
The date column stays in words until a payer commits in writing.
What owners ask before they sign.
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 files one application per payer, at $350.
How long will it take?
Commercial payers take months, Medicare is usually faster, Medicaid varies by state. A complete file helps; it cannot set the payer's clock.
Can a new provider see patients before they are enrolled?
Yes. The risk is billing a payer under their name before its effective date, since nothing billed for service before that date is guaranteed payment. 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.
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 either way. Once the dates arrive, we run the rest of the revenue cycle for any practice that wants it: claims, payment posting, denials and appeals, and the Friday board. That is billing and revenue cycle, priced from the practice's own numbers in the agreement.
Bring your payer list, even a rough one.
The free review shows which applications the practice needs, and what each costs, before anything is signed.
We get back to you as quickly as possible.