Credentialing Chaos? Here’s How to Get It Right the First Time
Credentialing Delays Are Costing You Big—Here’s How We Recovered $400K for One Practice
Imagine working for months—seeing patients, doing procedures, submitting documentation—only to discover you can’t bill a dime because your credentialing wasn’t done right.
That’s the exact situation a North Carolina-based anesthesia group found themselves in when they came to Advanced Healthcare Revenue (AHR).
Their Medicaid enrollment had been sitting in limbo for nearly 9 months. Payers weren’t responding. Claims were piling up. Their admin team was overwhelmed—and the providers were frustrated and losing trust in the billing team.
That’s when AHR stepped in—and helped them recover over $400,000 in backpay.
Let’s break down what went wrong, how we fixed it, and how your practice can avoid the same nightmare.
What Exactly Is Credentialing?
Credentialing is the process of verifying a provider’s qualifications—education, licensure, training, and work history—so they can legally and ethically treat patients and bill insurance companies.
But here’s the catch: Credentialing and enrollment are not the same thing—and you need both.
Credentialing confirms you're qualified
Enrollment ties you to specific payers (like Medicaid or Aetna) so they can reimburse you
Miss one step, and your revenue gets stuck.
The Real-Life Scenario: What Went Wrong in North Carolina
A growing anesthesia group with four CRNAs had recently onboarded new providers and began servicing multiple surgery centers and hospitals. Their internal admin team submitted their Medicaid NCTracks enrollment—but didn’t follow up.
They assumed "no news" meant "everything is processing."
Meanwhile:
Over $400,000 worth of claims were denied
Payers cited “non-participating provider” errors
One provider’s NPI wasn’t linked to the group’s Type 2 NPI
CAQH profiles hadn’t been re-attested in over 6 months
No one realized Medicaid required fingerprinting and site verification
The Impact
The practice:
Couldn’t bill Medicaid
Couldn’t collect on anesthesia claims
Was losing trust with referring surgeons
Had staff working overtime to resubmit claims manually
Was close to letting go of one CRNA due to cash flow issues
What We Did at AHR (Our Credentialing Game Plan)
As soon as AHR took over, we executed a 5-step intervention plan:
✅ Credentialing & Enrollment Audit
We did a full provider/payer matrix to identify exactly which providers were not active, enrolled, or linked correctly.✅ Fixed the CAQH Profiles
We updated all expired CAQH records and submitted attestation forms, correcting mismatched specialties and outdated addresses.✅ Medicaid NCTracks Escalation
Our credentialing team contacted NCTracks directly, submitted updated site verification, and escalated fingerprinting delays through the state liaison.✅ Retroactive Enrollment Requests
Once credentialing was complete, we submitted retroactive effective date appeals backed with documentation and service logs.✅ Claim Resubmission & Follow-up
Our A/R team tracked and reprocessed over 200+ claims after the provider was officially enrolled.
The Outcome: $400,000+ Recovered
Within 8 weeks, the group received:
Medicaid enrollment approvals for all four providers
Retroactive effective dates for services dating back 7+ months
$400,000+ in backpay processed and paid
A custom credentialing tracker to avoid future delays
Confidence to grow their team with new hires
The Takeaway: Credentialing Isn’t Just Paperwork—It’s Profit Protection
Credentialing and enrollment delays don’t just create admin stress—they choke your revenue cycle.
At AHR, we treat credentialing like the foundation of your financial health:
📋 We track every payer’s unique process
🧠 We know the red flags and avoid costly mistakes
📞 We follow up relentlessly until you’re active and enrolled
💼 We handle everything—so your team doesn’t have to
📈 Who We Help
New solo providers
Growing group practices
Multi-specialty clinics
Behavioral health, anesthesia, primary care, therapy
MSOs and startups preparing for scale
Hospitals and Clinics
Ready to Get Credentialed—and Get Paid?
Let’s avoid the revenue freeze and get you set up the right way.
📞 Call us at 415.857.2854
📩 Or send us a message [insert your website contact link]
We’ll handle the paperwork so you can focus on patients—not problems.