Handle a payer "pending info" request

For: Credentialing Coordinator · Time: 15–45 min per request · Frequency: Common — most apps hit this at least once

Trigger

A payer responded with a request for additional info: updated CV, attestation re-signing, a specific document, a clarification on practice location, an explanation of a disclosure (malpractice claim, license action). Application status moves to pending_info.

Outcome

The requested info is delivered to the payer in their preferred channel (portal, email, fax), the application moves back to in_review, and you have a record of what was sent and when.

Where

• Applications → Detail
• Provider detail → Documents tab

Steps

1. Read the request CAREFULLY. Payer requests are often ambiguous. Common patterns:
   • "Missing CV updated within past 6 months" — most CVs are stale; ask provider for a refreshed one.
   • "Explanation of 2018 malpractice claim" — provider writes a letter explaining the incident, outcome, lessons learned.
   • "Practice address verification" — payer cross-checked NPPES vs your application; the addresses don't match. Update one to match the other.
   • "Updated W-9 / Voided check" — usually for EFT enrollment, often piggybacks on credentialing.
2. Log the request. Application detail → Notes → New → paste payer email or transcribe phone call. Tag with pending_info_requested so it's searchable later.
3. Gather the materials. Provider has 24–72 hours to respond to you; you have ~14 days to the payer (most payers' default).
4. Format per payer requirements. Some payers want a single PDF; some want attached PDFs in an email; some want fax. The "Notes" section of the application typically records the submission preference from earlier in the application.
5. Submit the response. Use the channel the payer requested.
6. Document what you sent. Application detail → Attachments → upload a copy of what was sent to the payer. Add a note: "Responded to pending info on YYYY-MM-DD via [channel]". This is your proof if the payer later claims they didn't receive it.
7. Transition status: pending_info → in_review.
8. Schedule a follow-up. Followups tab → New → 14 days from response. If you don't hear back, chase.

Watch-outs

• "Pending info" can become a black hole. Payers sometimes ask for info, never acknowledge receipt, and let the file rot. ALWAYS follow up after 14 days. The Agency Owner's stale-applications dashboard flags anything >90 days in pending_info.
• Don't send sensitive docs over unencrypted email. Malpractice histories, attestations of disciplinary actions — these are PHI/PII. Use the payer's secure portal if they have one; the credentialing fax line if they don't.
• Multiple pending_info rounds happen. Round 1 → respond → payer asks for one more thing → round 2. Don't be discouraged; document each round in notes with a date.
• Provider may NOT have the info. Sometimes a payer asks for something a provider can't produce (e.g. a residency verification from 1995 from a program that closed). Document the impossibility, propose an alternative (e.g. medical school verification + state board attestation), and submit that. Payers will accept reasonable substitutes — they just won't suggest them.
• A pending_info that asks "did you mean to apply to this entity?" is a routing issue. The payer thinks your app went to the wrong subsidiary or product. Don't just respond; call the payer to confirm where it needs to go before you re-submit.

Related jobs

• Work an application from intake to credentialed — the broader workflow
• Kanban planning — surface pending_info cards weekly so they don't rot

Something on this page doesn’t match what you see in the app? Email support@credentik.com and we’ll fix the guide.