Clinics & Physician Groups
Enroll, credential, and keep every provider active with payers—without gaps.
Why Credentialing & Data Consistency Matter for Clinics
New providers typically take 90–120 days to clear payer credentialing; incomplete packets or mismatched data push that longer. Missed CAQH re-attestations, stale practice locations, or inconsistent NPIs can stall claims or cause plan terminations. We keep CAQH profiles current, align PECOS/NPPES data, file payer applications, and track recredentialing so your group stays billable.
Why Clinics Lose Time—and Revenue—and How We Prevent It
Avoid delays from rejected applications and compliance errors with guidance that keeps your clinic on track from day one.
Frequent Issues
-
Expired or Un-attested CAQH
Payers can’t verify providers; enrollments stall. CAQH requires ongoing re-attestation and tracks changes in an activity log. -
Inaccurate NPI / Practice Details
NPPES name/type mismatches, missing active practice locations, or wrong TINs lead to denials. -
Missed Recredentialing / Revalidation
Most payers recredential every 2–3 years; Medicare revalidates every 5 years (3 for DMEPOS), and can request off-cycle reviews. -
Directory Non-Compliance (NSA)
Plans must verify provider directory entries at least every 90 days and reflect changes fast; failing to update risks member complaints and payment issues.
How We Support Clinics & Physician Groups
01.
Profile & Documentation Review
Confirm NPIs, locations, ownership, and disclosures; correct CAQH/NPPES variances.
CAQH Setup or Refresh
Upload documents, complete releases, and attest; set reminders for re-attestation.
02.
03.
Payer Enrollment Filing
Submit Medicare/Medicaid/commercial packets; address plan requests during verification. (Expect ~12–24 weeks depending on plan.)
For Less Than The Cost of One Employee
The Silver Plan
$850.00
Per Month
- Human Resources
- Accreditation
- Credentialing Medicare
- Credentialing – Home State HME License
- Credentialing – Home State Medicaid
- Risk Management Assessments and Reporting Forms are provided to you for implement.
- Patient Experience Survey, Complaint and Grievance Forms are provided to you for implementation
Home State Only
The Platinum Plan
1,550.00
Per Month
- Human Resources
- Accreditation
- Credentialing Medicare
- Credentialing – Home State HME License
- Credentialing – Home State Medicaid
- Credentialing – Out-of-State HME Licenses
- Credentialing – Out-of-State Medicaid Applications
- Credentialing – Commercial Insurance for In Network Benefits
- Risk Management Assessments and Reporting Forms are provided to you for implement.
- Patient Experience Survey, Complaint and Grievance Forms are conducted by QPI Healthcare Services
All States
Full H.A.R.P. Services Dedicated Program Manager
The Gold Plan
$1,250.00
Per Month
- Human Resources
- Accreditation
- Credentialing Medicare
- Credentialing – Home State HME License
- Credentialing – Home State Medicaid
- Credentialing – Commercial Insurance for In Network Benefits
- Risk Management Assessments and Reporting Forms are provided to you for implement.
- Patient Experience Survey, Complaint and Grievance Forms are conducted by QPI Healthcare Services
Home State Only
Compliance Benefits for Clinics & Physician Groups
Running a clinic or physician group requires accurate credentialing, licensing, and payer enrollment. Errors or missed deadlines can disrupt operations and delay reimbursement.
Need to onboard multiple providers or fix stalled enrollments? We’ll get your roster active and your data consistent.
Let's Talk Compliance
Common Questions Clinics Ask About Enrollment & Credentialing
How long does commercial payer credentialing take?
Most plans clear in 90–120 days, but it can vary by carrier and completeness of your packet.
How often do I have to revalidate with Medicare?
Generally every 5 years; DMEPOS every 3 years; CMS may also request off-cycle reviews.
What causes the most delays?
Incomplete CAQH, inconsistent NPI/name data, missing practice locations, and slow responses to plan requests.
What are the directory rules under the No Surprises Act?
Plans must verify directory entries at least every 90 days and update within 2 business days after receiving changes.
Are denial rates really that high?
Industry reports show denial rates near 10–20% in many settings; a large share never get resubmitted.