Provider & Network Operations
Credentialing & Payer Enrollment
Credentialing administration, payer enrollment, licensing, and privileging support for provider participation and network readiness.
Overview
A payer generally will not pay a provider as a participating provider until it has credentialed and enrolled them, and participation lapses when revalidations, re-attestations, licenses, and expirables are missed. The work is document-heavy, deadline-driven, and spread across CAQH, PECOS, state Medicaid systems, commercial payer portals, clearinghouses, licensing boards, and facility medical-staff offices.
Ellery Health Partners administers that work in four areas: credentialing files and CAQH maintenance; payer enrollment and revalidation; the NPI, EFT, ERA, and clearinghouse enrollments that follow; and state licensing and facility privileging. Expirables and renewal dates are tracked to reduce the risk of lapsed participation, and each application is followed to the payer’s determination.
What Ellery Health Partners handles
Credentialing administration
- Initial provider credentialing administration and recredentialing
- Primary-source verification support
- CAQH setup, maintenance, and re-attestation
- Credentialing file assembly and license and document collection
- Education, training, work-history, and malpractice-information tracking
- Expirable tracking
- Exclusion-screening administration where scoped
Payer enrollment
- Commercial payer enrollment
- Medicare enrollment and PECOS administration
- Medicaid, Medicare Advantage, and managed-care enrollment
- Individual enrollment, group enrollment, and provider-to-group linkage
- New provider and new location enrollment
- TIN changes, NPI changes, roster maintenance, and demographic updates
- Provider terminations and payer revalidation
- Application-status follow-up and payer-directory corrections
Related enrollment administration
- NPI and NPPES administrative support
- EFT enrollment and ERA enrollment
- Applicable EDI and clearinghouse payer enrollment administration
Licensing and privileging
- State-license application administration and license-renewal tracking
- DEA document and renewal tracking support
- Multi-state licensing administration
- Hospital privileging and ambulatory surgery center privileging administration
Where it sits in payer operations
Enrollment status determines whether claims will pay, and enrollment-related denials are among the most avoidable. Credentialing and enrollment connect directly to claims and A/R, denials and appeals, and payer contracting, since a contract is only useful once the provider is enrolled under it.
Within your existing systems
Ellery Health Partners performs this work inside the systems your practice authorizes for the assigned workflow: the EHR or practice-management system, payer portals, pharmacy benefit manager and specialty-pharmacy platforms, clearinghouses, CAQH and PECOS, and the payer telephone channels the work requires.
Your practice provisions the accounts, sets the permissions, and can modify or revoke access at any time. Nothing is moved into a separate Ellery Health Partners patient database.
Reporting and accountability
Ellery documents payer activity within the practice-approved systems used for the engagement, with supplemental operational tracking where appropriate. That tracking is aggregate and contains no protected health information; patient-level case detail stays in your systems.
Reporting appropriate to the engagement covers case status, last payer action, next follow-up, deadlines, determinations, unresolved issues and escalations, and the administrative barriers that recur.
Credentialing support built around your organization's needs.
Credentialing requirements differ by organization. Some teams need support resolving a defined enrollment backlog. Others need ongoing administrative attention across an active provider roster.
Ellery structures credentialing engagements around the work required rather than assuming every organization needs the same service package.
Defined Credentialing Projects
For new-provider enrollment, accumulated application backlogs, CAQH cleanup, revalidation projects, new-location enrollment, and other specific administrative objectives.
The written scope identifies participating providers, payer programs, deliverables, responsibilities, and the project's endpoint.
Ongoing Credentialing & Roster Administration
For organizations seeking recurring support with applicable provider-roster tracking, CAQH maintenance, recredentialing deadlines, outstanding applications, payer follow-up, and monthly reporting.
The written scope establishes the covered roster, responsibilities, reporting cadence, and recurring fees.
Both engagement structures begin with a Workflow Review and a written scope.
Service boundaries
Administrative scope and decision authority
- Credentialing, enrollment, licensing, and privileging decisions are made by the payer, board, or organization
- Ellery Health Partners provides credentialing administration and operational support, including application coordination, CAQH maintenance, payer enrollment, revalidation, status tracking, follow-up, and related administrative workflows
- Primary-source verification and formal credentialing determinations remain with the applicable payer, facility, health plan, or credentialing authority
- Provider attestations and signatures remain with the provider
- Where included in scope, exclusion screening supports the organization’s broader compliance program. Responsibility for the organization’s compliance program remains with the organization.
When work is scoped separately
Credentialing and payer enrollment are scoped and priced in writing based on provider, payer, program, facility, and project requirements. Scoped as projects:
- Onboarding a group of providers or a new location across many payers
- Hospital and ambulatory surgery center privileging
- State licensing, multi-state licensing, and DEA renewal tracking
- Clean-up of a lapsed or inconsistent enrollment record
- Directory accuracy programs across payers
Specialties where this work is concentrated
Get started with Ellery Health Partners
Tell us about your provider roster, payer programs, pending enrollment requirements, and the administrative support your organization needs. We'll review the information and identify an appropriate scope for discussion. No patient information is requested or accepted through this website.