A provider who is not enrolled with a payer cannot be paid by that payer. It sounds obvious, yet most practices lose money on it every year: a new physician starts seeing patients before the enrollment is effective, a revalidation deadline passes unnoticed, or an application sits in a payer queue for months because nobody called to check on it.
Revelrex runs the enrollment process for you. We gather the provider information once, prepare each application the way the payer expects it, submit it, and then follow up until it has an effective date. You see the status of every application from your dashboard.
Practices that benefit
- Practices hiring a new physician, nurse practitioner or physician assistant.
- New practices that need to be enrolled with commercial payers, Medicare and Medicaid before opening.
- Groups adding a location or changing their tax identification number.
- Practices with lapsed CAQH profiles or upcoming revalidation deadlines.
- Organizations that want one place to see enrollment status for every provider.
What usually goes wrong
Claims denied for "provider not enrolled"
A provider begins seeing patients, claims go out, and they come back denied because the enrollment was never completed or the effective date is later than the date of service.
Applications that stall
Payers rarely tell you an application is incomplete. Without scheduled follow-up, a missing signature page can add sixty days to an enrollment.
Revalidations that lapse
Medicare revalidation and commercial recredentialing arrive on different cycles. A missed one interrupts payment for every claim from that provider.
Information scattered across staff
NPI letters, licenses, DEA certificates and CAQH logins live in email threads and desk drawers. Every new application starts from scratch.
The actual work
Provider information intake
We collect the provider record once: NPI, taxonomy, licenses, DEA where applicable, board certification, education, work history, malpractice coverage and practice affiliations. Gaps are flagged before anything is submitted.
CAQH profile setup and attestation
We create or clean up the CAQH ProView profile, upload supporting documents and keep the attestation current, because most commercial payers pull from it.
Application preparation and submission
Each payer has its own form, portal or PECOS workflow. We prepare the application in the format that payer expects, obtain the signatures needed and submit it.
Follow-up on a schedule
Every application has a follow-up date. We contact the payer, record the reference number and the response, and escalate when a payer is outside its normal processing time.
Requests for additional information
When a payer asks for more, we tell you exactly what is needed, collect it and resubmit. You never have to interpret a payer letter yourself.
Effective-date tracking
When an application is approved we record the provider number, the effective date and the retroactive billing rules so your billing team knows when claims can go out.
Revalidation monitoring
Approved enrollments are tracked for revalidation and recredentialing dates so renewals start early, not after a payment stops.
What is included
- One application per provider per payer or entity (for example Medicare, Medicaid, a commercial plan or a hospital privileging packet where handled by Revelrex).
- Application preparation, submission and confirmation of receipt.
- Scheduled follow-up until approval, denial or closure, with every contact logged.
- Handling of requests for additional information.
- Effective-date and provider-number recording in your dashboard.
- Revalidation date tracking for applications Revelrex completed.
Not included
- Payer, CAQH, licensing board and hospital fees (paid by the practice).
- State medical licensing itself (we can track it, we do not apply for it).
- Contract rate negotiation with payers (available as a separate engagement).
- Payer, CAQH, state licensing or board fees are paid directly by the practice. Fees for expedited processing offered by some payers are not included.
What your practice needs to provide
- Provider identifiers and documents: NPI, SSN or tax ID where required, licenses, DEA, board certificates, CV with month and year dates, malpractice face sheet.
- Practice details: legal name, TIN, group NPI, locations, billing address, W-9 and, where applicable, the group Medicare PTAN.
- Signatures on payer forms, usually electronic, within a few days of our request.
- Access to or creation of CAQH and payer portal logins, ideally as delegated accounts.
Step by step
- 1
Intake
You complete the provider profile in your dashboard or send us the documents. We confirm what is missing within two business days.
- 2
Preparation
We build the CAQH profile and each payer application and send you anything that needs a signature.
- 3
Submission
Applications are submitted and the reference numbers recorded. The status changes to Submitted.
- 4
Follow-up
We follow up on each application on its scheduled date and record every payer response. Status changes are visible to you as they happen.
- 5
Approval
We record the effective date and provider number, notify you and your billing team, and set the revalidation reminder.
What you receive
A live enrollment tracker for every provider and payer, with status, reference numbers, follow-up dates and effective dates.
A complete provider credentialing file you can reuse for future applications.
Approval letters and welcome packets stored in your Documents area.
Monthly status summary during active enrollment work.
Add Credentialing to your Service Cart
A written proposal follows within two business days.
Frequently asked
How long does payer enrollment take?
It depends on the payer. Medicare through PECOS often takes 30 to 60 days. Commercial plans commonly take 60 to 120 days, and some take longer during recredentialing seasons. We cannot shorten a payer's internal review, but consistent follow-up removes the delays caused by incomplete files and unanswered requests.
Can a new provider see patients before the enrollment is effective?
They can see patients, but claims to that payer generally cannot be paid for dates of service before the effective date, unless the payer allows retroactive enrollment. We tell you each payer's rule so the practice can decide how to schedule.
What if we do not know how many applications we need?
That is common. Your service order records credentialing as needed at the agreed rate. Each completed application is listed on your invoice with the provider and payer name.
Do you guarantee approval?
No one can guarantee a payer's decision. Payers close panels, apply network adequacy rules and deny for history they consider disqualifying. What we guarantee is a complete, accurate application and documented follow-up until the payer gives a final answer.
Do you handle hospital privileges?
We prepare and track hospital and facility privileging packets when the facility allows a third party to coordinate them. Each packet counts as one application.
What information do you need from the practice?
Legal entity details, TIN, group NPI, W-9, locations and a signed authorization allowing Revelrex to act on the practice's behalf with payers. Your dashboard lists exactly what is outstanding.