New Clinic Lost 11 Weeks of Billable Revenue Before Hiring Us. We Fixed It in 34 Days.
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THE SITUATION
This group practice had been operating for six years. Solid reputation. Consistent referrals. In late 2023, they hired two licensed therapists and one psychiatrist to handle growing demand. All three were credentialed to practice clinically. None of them could bill insurance.
Eleven weeks after their start dates, all three providers were seeing patients and generating zero insurance revenue. The practice was absorbing their salaries in full while collecting nothing from payers. At $8,000–$12,000 per provider per month in unbilled services, the math was painful.
Their office manager had submitted CAQH profiles and sent applications to four payers. She had no follow-up system, no payer contact list, and no idea that the applications were sitting incomplete.
They called us after their accountant flagged the cash flow gap.
WHAT WAS ACTUALLY WRONG
A full credentialing audit in week one showed three specific failures.
CAQH profiles were incomplete. Two of the three providers had outdated malpractice insurance dates in CAQH ProView. Payers pull directly from CAQH. Incomplete profiles mean auto-rejection before a human even reviews the application.
Wrong NPI taxonomy codes. The psychiatrist’s NPI was registered under a general mental health taxonomy, not psychiatry. Two commercial payers had flagged this and returned the application. No one at the practice received the notification.
No follow-up cadence. Commercial payers require active follow-up every 10–14 days, or applications stall. The office manager had submitted and waited. Aetna and Cigna had both requested additional documentation three weeks earlier. No one had responded.
These are not unusual mistakes. They are the three most common credentialing failures we see in behavioral health practices, and every one of them is preventable.
WHAT WE DID
Days 1–3: Corrected all three CAQH profiles. Updated malpractice certificates, verified license expiration dates, and corrected taxonomy codes. Re-attested all profiles before submitting anything.
Days 3–7: Responded to outstanding payer requests. Pulled the Aetna and Cigna correspondence, submitted the requested documentation with a direct payer contact follow-up call. Both applications moved to active review within five business days.
Days 7–34: Ran parallel credentialing across four payers. Rather than submitting sequentially, we ran all four payer applications simultaneously with a dedicated tracking sheet and a 10-day follow-up cycle. Every payer contact was logged with a name, date, and next action.
Interim billing setup. While credentialing was completed, we set up a locum tenens billing structure for the psychiatrist so existing patient services could be billed under the supervising physician, recovering partial revenue during the gap.
THE RESULTS
| Metric | Before | After |
|---|---|---|
| Days to Active Billing | 77+ days (still pending) | 34 days |
| Providers Billing | 0 of 3 | 3 of 3 |
| Payers Active | 0 | 4 |
| Monthly Revenue Recovered | $0 | $31,400 |
| Interim Billing Revenue | $0 | $9,200 (locum setup) |
All three providers were credentialed and billing within 34 days of our engagement. BCBS approved in 28 days. Aetna and Cigna in 31. Medicaid in 34.
The practice recovered $9,200 in interim billing revenue during the credentialing window revenue they would have written off entirely.
Stop Credentialing Losses!
Stop losing revenue to credentialing. Delays of 90 days can cost $24K–$45K per provider — more than $100K for multiple hires. We manage credentialing end-to-end so new providers bill immediately.