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Feature · Billing & revenue cycle

Credentialing and billing in one place

The revenue cycle workspace sits next to credentialing, so you can see when an enrollment is what's holding a claim back, stop a claim before it goes out for a provider who was not credentialed, and invoice your own practice clients for the work.

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Credential-gated claims

Catch the credentialing problem before the denial

A claim for a provider who was not yet in-network on the date of service is a denial waiting to happen. Because enrollments and claims share one workspace, Credentik checks each claim against the provider’s enrollment with that payer, in that state, on that date.

  • Warn (the default): the result shows on the claim and nothing is stopped
  • Block: submission is refused for not-credentialed or pending providers, unless an admin records an override with a reason
  • Overrides are tied to the facts they were made on and lapse if those change
  • Every override and blocked submission is in the audit log

Revenue cycle workspace

  • Charges and claims, including 837 import
  • Denials, with appeal letter drafts
  • ERA 835 posting and payments
  • A/R aging and follow-up tasks
  • Eligibility checks and authorizations
  • Fee schedules and underpayment detection
  • Write-off approvals
  • Patient statements, reminders and payment links
Agency invoicing

Bill your own clients for the work

Most small billing and credentialing companies invoice from a separate accounting tool, pulling numbers from reports by hand. In Credentik, each billing client has its own pricing, and a month of claims, collections, applications and providers becomes an itemized invoice.

Preview what last month would have been before you send anything, and send invoice reminders when a client is late.

Pricing per client

  • Billing: percentage of collections, per claim, flat monthly or hybrid
  • Credentialing: per application or per provider per month
  • One-time setup fee, billed once
  • Add-ons such as statements, eligibility checks and appeals
One view of the client

See enrollment and revenue side by side

When a practice asks why collections dropped, the answer is often an enrollment that expired or never went through. With credentialing and billing in one place, your team sees the enrollment, the claims and the denials for that provider and payer on the same screen.

Pricing your services? Read how to price credentialing services for the common models and how to choose between them.
Questions

Frequently asked

What is a credential-gated claim?
Before a claim is submitted, Credentik checks whether the rendering provider was credentialed with that payer, in that state, on the date of service. In warn mode it shows the result and lets the claim go; in block mode it stops submission of a claim for a provider who was not credentialed or was still pending, unless an agency admin records an override with a reason. Missing data warns rather than blocks.
Can we bill our practice clients from Credentik?
Yes. Set the pricing for each billing client, such as a percentage of collections, a per-claim fee, a flat monthly fee or a mix, plus credentialing fees per application or per provider per month, a one-time setup fee and add-ons. Credentik turns a month of activity into an itemized invoice you can review and send.
Is the revenue cycle workspace an extra module?
No. Claims, ERA, denials and patient payment links are included on the Agency and Growth plans, alongside credentialing.
Does Credentik connect to a clearinghouse?
Credentik imports 835 remittance files and 837 claim files and can check eligibility once a clearinghouse connection is set up. Electronic claim submission through Stedi is in pilot, and automatic ERA download from Availity is coming soon; until then you submit claims from your existing clearinghouse or EHR. Talk to us about your clearinghouse setup during the trial.

Keep reading

Who it’s forBilling and credentialing software for medical billing companiesClaims, ERA and denials for every client, with enrollment checks and client invoicing.Read more FeaturePayer enrollment tracking for every client, on one boardEvery payer application for every client on one board, with follow-ups and effective dates.Read more GuideHow to price credentialing servicesPer application, per provider, maintenance and retainer models, and what to put in scope.Read more

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