Accelerating Provider Enrollment from 120 Days to 45 Days for a Rapidly Expanding Urgent Care Network
Service
Credentialing & EnrollmentIndustry
Urgent CareLocations
12 sitesProviders
40 cliniciansTimeline
OngoingRegion
USAbout This Project
The growth rate of an urgent care chain had been very fast, with an average of two to three new centers being added every quarter. The challenge for this particular company is to complete the credentialing process with around 15 different health plans, with an average turnaround time of four months, which prevented the new centers from generating income.
Challenges & Solutions
| Challenges | Solutions |
|---|---|
| Applications needed for Medicare, Medicaid, and 13+ commercial insurance companies, each having their own set of rules and timelines. | Credentialing staff created a standardized enrollment process for all payers. |
| Administrative personnel handling the credentialing process along with other tasks — leading to delays and denial of claims. | Complete database of all providers created — CAQH profiles pre-filled for instant application submission within one week of hiring. |
| No centralized monitoring system — management lacked visibility into the credentialing process for each provider. | Real-time credentialing tracking system implemented, providing a live dashboard for all providers and payers for management. |
| Providers met with patients for several weeks without knowing that the application was denied because of incomplete information. | Weekly follow-ups from all payers to avoid any delays in applications, and also back-billing of revenue generated while onboarding. |
Key Deliverables & Impact
The average enrollment period for providers went down from 120 days to 45 days — a 62% reduction. Using retroactive billing contracts, the network was able to salvage approximately $95,000 in losses per site through the periods where there were no providers enrolled. The denial rate on applications reduced from 35% to less than 8%.
The Result
Credentialing services from CureMed are specifically designed for growing healthcare facilities where patient enrollments equal income. With the help of experienced staff, structured processes, and timely payer communication, CureMed made it possible for the urgent care facility to expand — while continuing to bill seamlessly at each new site.
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