Credentialed as primary care
A center enrolled as family practice rather than urgent care gets primary care fee schedules and misses urgent care case rates. Specialty designation matters at enrollment.
Urgent care lives on walk-in volume from every payer, and it staffs with rotating physicians, NPs and PAs who change often. We credential the center with urgent care-specific contracts, onboard providers fast, and keep the roster synchronized across every site and payer.
An urgent care center that turns away patients because it is out of network with their plan loses the visit and the patient. Being in network with every meaningful payer is not optional. At the same time, urgent care fee schedules are different from primary care, with global visit rates and S-code arrangements at some plans, and the provider roster turns over constantly.
ClainetRCM credentials urgent care centers as organizations with the right specialty designation, negotiates urgent care contract terms where possible, and runs a rolling onboarding process so new providers are payable within weeks of their start date.
A center enrolled as family practice rather than urgent care gets primary care fee schedules and misses urgent care case rates. Specialty designation matters at enrollment.
Rotating clinicians who are never fully credentialed generate claims billed under the medical director, which is improper and unsustainable.
Each location must be enrolled with each payer. A new site that is not added produces denials specific to that address.
One coordinator owns every file from intake to effective date.
Urgent care taxonomy and payer specialty code drive fee schedules. Enrollment should reflect it.
Some plans pay a global urgent care visit rate (S9083) or facility fee (S9088); others use standard E/M schedules. See payer contracting.
High turnover of NPs and PAs; each needs credentialing and linkage. See NP credentialing and PA credentialing.
Workers compensation and employer contracts require separate enrollment with carriers and networks.
Provider by site by payer matrix maintained. See group practice credentialing.
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
Payers are contacted on a schedule. Requests for more information are answered the same business day.
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Medicare in 30 to 60 days and commercial plans in 90 to 150 days for a new provider, or 30 to 90 days to link an already-credentialed provider to the group. We start before the hire date so the gap is as short as the payers allow.
Not properly. Billing one provider's services under another's NPI is misrepresentation. Medicare allows retroactive billing after enrollment, and some commercial payers allow limited exceptions, which we confirm per plan.
Nearly every plan with membership in the area, yes, because walk-in patients come from all of them. The exception is plans whose urgent care rates are below cost, which we identify in contract review.
Yes. Occupational medicine volume requires enrollment with workers compensation carriers, state fee schedules and employer networks, which we handle alongside health plan credentialing.
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.