Your biller knows which payers have which providers. Mostly.
It lives in a spreadsheet, or in someone's head, and it is right until the week it isn't. A re-attestation window closes. An address on one system stops matching the address on another. A payer starts rejecting claims and nobody can say when it started. So we watch it instead, reading the public sources that decide the answer, and you hear about it while there is still time to fix it.
Every date the practice has to keep.
Not only the providers. The nurses, the practice licences, the insurance policies and the vendor agreements. Built once, then watched, by us rather than by software you have to remember to log into.
Credentialing and payer enrollment
- NPI record, state licence, board certification, payer directory listing
- Provider by payer matrix, each Medicare Advantage plan on its own line
- Mismatch alerts when two public records stop agreeing
Staff credentials
- Nurse and allied licences, checked against the national nurse licensure database
- CPR and BLS expiry
- Annual HIPAA and OSHA training dates
Licences and policies
- CLIA certificate, state facility licence, x-ray permits, business licence
- Malpractice, workers compensation and cyber policy dates
- Vendor and BAA register, with review dates
Exclusion screening, and the file
- OIG, SAM and state Medicaid, for every member of staff and not only providers
- A dated evidence file you can hand to anyone who asks
- Alerts at 120, 90, 60 and 30 days before anything lands
When your records quietly stop agreeing.
Nothing looks broken. Every system says something, and each one thinks it is right.
One provider, three public sources
What we never touch.
Your systems
- No connection to your EHR or practice management system
- No access to your network, and no account to create for us
- Everything we read is a public record about a provider
Patient information
- Provider credentialing records are not patient records
- No protected health information enters this work
- The decision stays yours. We report what the sources say and where they disagree. What to file, and when, is your call
By how many providers you have.
| Charge | 1 to 5 providers | 6 to 15 | 16 to 30 |
|---|---|---|---|
| Setup, one time | $2,000 | $3,500 | $5,000 |
| Watch, per month | $249 | $399 | $599 |
| Annual, prepaid | $2,490 | $3,990 | $5,990 |
Annual prepaid is two months free. Billing companies and multi-practice groups are priced per provider instead: $39 per provider per month, with a 25 provider minimum. Adding a new provider mid-year is $350.
What practices ask first.
Our biller already does this.
Good, and this does not replace them. It does not do their job. It ends the part of their job where they log into nine portals to answer one question. Practices without a dedicated biller get the same result, usually through whoever runs the office.
Do you need access to our systems?
No. Everything we read is a public record about a provider. There is no connection to your EHR, your practice management system or your network, and there is nothing to install.
Is any patient information involved?
None. Provider credentialing records are not patient records, and nothing in this work touches protected health information.
How often does CAQH actually need attention?
Every 120 days. Providers are asked to attest that their information is still accurate, and the request arrives without any dramatic trigger attached, which is exactly what makes it easy to lose track of. We wrote about who owns that job in a longer piece on CAQH re-attestation.
We are enrolled with Medicare. Does that cover Medicare Advantage?
No. Medicare Advantage plans credential on their own. A provider can be enrolled with CMS while not being enrolled, or no longer being enrolled, with individual Medicare Advantage plans. That is why the matrix lists each plan on its own line instead of one row for Medicare.
We will email you once. Not a newsletter.
Got it.
We will email you when this opens. If you want to tell us how your practice handles this today, reply to that email. It shapes what gets built.