Billing and credentialing for a new behavioral-health program.

Start when you sign the lease. Your organizational NPI (National Provider Identifier), tax ID and state license go into the payer applications. Medicare's enrollment rule lists all three among the documents to submit.

The order is entity and license first, then NPI, then payer applications as soon as each has what it needs. EHR and clearinghouse setup run alongside. One rule is fixed: no claim goes to a payer until that payer confirms enrollment and an effective date.

Our credentialing and payer enrollment work covers CAQH setup (the shared profile payers use to credential providers), payer applications, contracting where a network contract applies, and EDI and ERA enrollment (electronic claims out, electronic remittance advice back). Each individual provider is credentialed in addition to the organization.

Every payer runs its own clock, so no single number covers them all. If your program can enroll in Medicare, Medicare publishes processing standards for the contractors that handle its enrollment. For a complete web application, they are 15 calendar days for 95 percent of applications and 50 for all of them. Both apply when there is no site visit, follow-up request or fingerprints. Where any of those is needed, the figures are 50 calendar days for 95 percent of applications and 85 for all of them. Those clocks start when the contractor receives the application. For a community mental health center, contractor processing is only the first step. The contractor sends its recommendation to the state, and the center goes through a state survey. CMS, the federal agency that runs Medicare, signs the provider agreement before the center is approved.

We do not quote a range for commercial plans or state Medicaid programs. Ohio Medicaid publishes no processing time. We file early and track every application to a decision.

A payer rejects or denies a claim sent while enrollment is pending, whatever coverage the patient has. The same happens to a claim for any date before the payer's effective date, the first date of service it will pay for. Half-finished EDI and ERA setup fails a different way: claims transmit, but the remittance advice never routes back. We keep a tracked enrollment list.

We confirm the entity, register the NPI if needed, and file payer applications in the order that lets you bill soonest. We set claim rules for each level of care you will run.

Sample claims are built and checked against payer rules before any real claim goes out, and claim status reporting starts with the first one. No claim goes out before your program is licensed to operate. The exact order goes into your written scope, set against your open date.

Nothing has to be finished. We need to know where each item stands.

Setting up billing for a new program is part of our program scaling, operations and development work. It starts with an assessment that sets the written scope and a fixed price.