The first week with a new client decides how the next three months go. Applications stall on missing documents and missing access far more often than on payers. Collect everything up front, in one place, and the rest of the work becomes follow-up instead of chasing.
Tip: send the practice and each provider one request with everything on the list, rather than asking for items one at a time. A portal or document request link that tracks what has arrived saves dozens of emails.
The checklist
- Sign the agreement and BAA
- Service agreement: scope (payers, providers, services), fees, payment terms
- Client responsibilities: what they provide, and by when
- Business Associate Agreement if you will handle protected health information
- Who at the practice can approve and sign on its behalf
- Collect practice information
- Legal business name, DBA and tax ID, with a signed W-9
- Group (type 2) NPI and taxonomy
- Every service location, billing address and mailing address
- Owners, officers and managing employees (payers and Medicaid ask for these)
- Bank details for electronic funds transfer, and a voided check or bank letter
- Existing payer contracts and group IDs
- Collect the provider roster
- Full legal name, individual NPI, credentials and specialties
- Locations each provider will practise at, and start dates
- Payers each provider needs, and any they are already enrolled with
- Collect provider documents
- State licenses for every state of practice
- DEA registration and state controlled substance registration, where applicable
- Board certification, or eligibility
- Current CV with month and year for work history, and explanations for gaps
- Education and training (diplomas, residency, fellowship)
- Malpractice certificate of insurance and claims history
- Hospital affiliations or admitting arrangements, if any
- A signed authorization and attestation, where the payer requires one
- Get access and authorizations
- CAQH ProView: access to each provider’s profile, and their attestation date
- Medicare PECOS: a surrogacy connection through the CMS Identity & Access system, so you can work the enrollment for the provider or group
- State Medicaid provider portal access
- Payer portal access where the client already has accounts
- Audit current enrollments
- Every existing enrollment, its status and effective date
- Upcoming recredentialing and revalidation dates, including Medicare revalidation due dates and the state Medicaid cycle
- License, DEA, board and malpractice expiration dates
- A first exclusion screening against the OIG LEIE, SAM.gov and the relevant state Medicaid lists
- Agree payer priorities
- Which payers matter most for the practice’s patients and revenue
- Target start dates for new providers or locations
- Whether the practice will see patients before enrollment is effective, and the billing risk if so
- Set up the client in your system
- Create the practice client, its locations and providers
- Create each application with an owner and a first follow-up date
- Enter every expiration and recredentialing date so reminders run on their own
- Send document requests for anything still missing
- Invite the practice and its providers to their portals
- Agree reporting and start work
- How the client will see progress (portal, weekly summary, or both)
- One named contact on each side
- Submit the first applications and schedule the first follow-ups
After onboarding
Once applications are moving, the work becomes follow-up and maintenance: checking status on a schedule, answering payer requests quickly (Medicare contractors, for example, generally give 30 days to respond to a development request before an application can be rejected, per CMS, 2017), keeping CAQH attested, and starting recredentialing well before each due date.
Onboarding in Credentik
Add the practice and look providers up by NPI, import a spreadsheet, or send each provider an onboarding link. Document requests track what has arrived, the requirement checklist shows what is still missing for each payer, and the practice gets its own branded portal from day one. See client portals.