Privileges at every facility
A surgeon who operates at two hospitals and an ASC needs three separate credentialing files and privilege sets, each with its own committee cycle.
Specialty credentialing program
Orthopedic Credentialing Services
Orthopedic surgeons need surgical privileges at hospitals and ASCs, credentialing with every commercial and government payer, workers compensation enrollment, and often DMEPOS enrollment for bracing. We coordinate all of it so surgeons operate and bill from their first week.
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
- Privileges at each hospital and ASC
- Workers compensation enrolled separately
- DMEPOS for in-office bracing
- PAs and therapists linked to the group
- Typical full timeline: 5 to 6 months
Orthopedics is a surgical specialty with an unusually wide payer mix: commercial plans, Medicare, Medicare Advantage, workers compensation carriers and auto liability. Surgeons operate at hospitals and ambulatory surgery centers that each require credentialing and delineated privileges. Practices that dispense braces, boots and other DME need a separate Medicare supplier enrollment.
ClainetRCM credentials orthopedic surgeons, sports medicine physicians, PAs and therapists with every payer, manages privileges at each facility, enrolls the practice with workers compensation networks and handles DMEPOS enrollment for dispensing practices.
Where this usually goes wrong
Workers compensation overlooked
Work injuries are a large share of orthopedic volume in many markets, and workers compensation carriers and networks require their own enrollment and fee schedule agreements.
DME billed without supplier enrollment
Bracing dispensed in the office and billed to Medicare requires DMEPOS enrollment. Without it, the practice is not paid for the device.
What ClainetRCM handles for you
One coordinator owns every file from intake to effective date.
- Complete surgical file with board certification, fellowship training and case logs
- Medicare, Medicare Advantage, Medicaid and commercial credentialing with orthopedic and subspecialty designations
- Hospital and ASC privileges applications with delineated surgical privileges at each facility
- Workers compensation carrier and network enrollment with state fee schedule setup
- DMEPOS supplier enrollment for practices that dispense bracing and orthotics
- PA, NP and therapist credentialing linked to the group
Orthopedic credentialing components
Facility privileges Hospitals and ASCs, each with its own application and privilege delineation. See hospital privileging and ASC credentialing.
Workers compensation Carrier enrollment, PPO networks and state fee schedules; separate from health plan credentialing.
DMEPOS Supplier enrollment for in-office bracing. See DME Medicare enrollment.
Advanced practice providers PAs for surgical assist and clinic, credentialed and linked. See PA credentialing.
Therapy In-house PT and OT enrolled under the group or separately. See physical therapy credentialing.
Billing Our orthopedic billing program handles surgical globals and modifiers once you are enrolled.
How the work runs
The sequence is the same for every payer and provider type; what changes is which documents and portals each step touches.
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
After enrollment
Orthopedic billing
Surgical globals and modifier accuracy. Once your providers are payable, the same team keeps the claims moving.
Frequently asked questions
Payer credentialing 90 to 150 days, facility privileges 90 to 180 days per facility, workers compensation networks 30 to 90 days. Running them together, a surgeon is usually fully payable within five to six months.
Yes. Each ASC credentials and privileges its surgeons independently, and the surgeon must also be credentialed with payers for professional fees at that location.
Workers compensation is regulated by state, with state fee schedules and carrier-specific or network-specific enrollment. It does not run through CAQH in most cases and is handled separately from health plan credentialing.
No. Orthotic devices billed to Medicare require DMEPOS supplier enrollment, with accreditation exemptions available for physicians who furnish certain items to their own patients. We confirm what applies.
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.