Prerequisites
- The group already contracted with the payers
- A credentialing tracking grid
- The new clinician’s documents assembled
The per-hire pipeline
1
Start at offer acceptance, not at start date
Credentialing takes 90–180 days. Starting when the clinician arrives means three to six months of a salaried clinician who cannot bill.Kick off the moment the offer is accepted and the licensure path is clear.
2
Collect the document packet
- Current state license(s)
- DEA registration and state controlled substance registration where applicable
- Board certification
- Medical school and residency/fellowship documentation
- Malpractice certificate of insurance and claims history
- Complete work history with no unexplained gaps
- CV in the format payers accept
- Government ID, SSN
- Type 1 NPI
- Hospital privileges, or the admitting arrangement if none
3
Run primary source verification and screening
Document each with a date. Re-run exclusion checks monthly thereafter.
4
Set up or update CAQH
New profile if they don’t have one; otherwise update the existing profile with your practice location and re-attest.Authorize every payer you’ll submit to. An unauthorized payer cannot retrieve the profile and the application waits.
5
Submit to every payer, in parallel
Not sequentially. All applications go out in the same week.For each payer: link the clinician to the group’s existing contract rather than initiating a new contract. This is a different (and faster) process than group contracting.
6
Submit Medicare 855I and 855R
Individual enrollment plus reassignment of benefits to the group. Without the 855R the group cannot bill for their services.
7
Submit Medicaid and each MCO
Per state, per plan.
8
Track and follow up every two weeks
Applications go quiet rather than getting denied. Log every contact.
9
Record every effective date
You cannot bill for services before the later of the group contract effective date and this clinician’s provider effective date, for that payer.
10
Enter the recredentialing date on the compliance calendar
Typically a three-year cycle per commercial payer.
The tracking grid
At two clinicians and three payers a spreadsheet is fine. At twenty clinicians, ten payers, and five entities you are tracking a thousand rows and credentialing software earns its cost. Columns you need:Managing the 90–150 day gap
A salaried clinician who cannot bill is expensive. The options, with their limits:Verify it worked
- Pipeline started at offer acceptance
- Full document packet collected
- Primary source verification complete and dated
- OIG LEIE and SAM.gov clear, documented
- CAQH complete, all payers authorized, attested
- Applications submitted to every payer in parallel
- Medicare 855I and 855R submitted
- Medicaid and every MCO submitted
- Follow-up log maintained
- Every effective date recorded
- Recredentialing dates calendared
- Monthly exclusion re-screening in place