Provider enrollment delays can cost a practice $10,000 to $30,000 per provider per month in lost revenue. Here are the five mistakes we see most often.
1. Incomplete CAQH Profile
A stale or incomplete CAQH profile blocks downstream enrollment with most commercial payers. Re-attest quarterly and keep all documents current.
2. Missing Hospital Privileges Documentation
Many payers require evidence of active hospital privileges. Maintain a current list of privileges with expiration dates.
3. Skipping Re-credentialing Deadlines
Re-credentialing typically happens every 2 to 3 years. Missing the window can pause your billing privileges.
4. Inconsistent Provider Data
Name spelling, NPI, TIN, and address mismatches across payers, CAQH, and PECOS are a leading cause of enrollment rejections.
5. Not Tracking PECOS Status
For Medicare, PECOS status drives everything. Monitor it monthly.
Talk to our credentialing team for help.