Every Week of Delay Is Revenue Left Unbilled
Credentialing is not about the paper but is a monetary process. If a provider is unable to get credentialed to be billable in-network, then he will either provide services without making any profit or simply wait until he gets credentialed to begin providing service. Commercial payers normally take 60 to 120 days to review an application, even if one page is missing. The Medicare system will only cover up to 30 days prior to the application.
Credentialing That Gets Providers Billing Faster
Resilient MBS is a medical credentialing company for physicians which specializes in payer enrollment, licensing, and re-credentialing of physician practices within the United States. All our applications are prepared in accordance with payer and federal requirements, allowing your providers to become in-network with no loss of revenue.
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From Application to Active Status in Six Clear Stages
Our provider enrollment and credentialing services follow a fixed workflow, so every file is complete before it reaches a payer. You get one point of contact and status updates at each stage.
Enrollment Services Built Around Your Provider Roster
Our provider credentialing services cover the full provider lifecycle, from a new hire’s first application to ongoing maintenance.
| Service | What It Delivers |
|---|---|
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New Provider Credentialing |
Complete applications for physicians, NPs, PAs, therapists, and behavioral health clinicians.
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Medicare and Medicaid Enrollment
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Enrollment and Identity and Access management setup, plus state Medicaid program applications.
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Commercial Payer Enrollment
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Group and individual contracting with national and regional plans
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Re-Credentialing and Revalidation
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Tracking of the three-year payer cycles and five-year Medicare cycles.
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Provider Directory Maintenance |
Accurate listings that meet payer verification requirements.
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Licensing and Registrations
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State licenses, DEA, CLIA, NPI, and taxonomy updates.
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Is a New Provider Waiting to Start Billing?
Send us the roster and target start dates. We will return a payer-by-payer timeline within one business day.
Federal and Payer Rules Now Shaping Credentialing Files
Credentialing standards continue to evolve. We monitor federal and payer requirements to keep provider files accurate, compliant, and ready for approval.
Provider Directory Compliance
Every 90 days
New Requirement
Health plans must verify provider directory information every 90 days and update changes within two business days of receiving them.
Our Response
We regularly confirm addresses, contact details, and patient availability to prevent directory inaccuracies, payer removal, and patient complaints.
Medicare Revalidation
Five-year cycle
New Requirement
Most Medicare providers must revalidate every five years and report ownership changes within 30 days and other practice changes within 90 days.
Our Response
We monitor revalidation deadlines, track reportable changes, and submit documentation early to protect billing privileges and prevent payment interruptions.
Continuous Exclusion Screening
Ongoing monitoring
New Requirement
Federal healthcare programs prohibit payment for services involving excluded individuals or entities, requiring ongoing exclusion checks.
Our Response
We conduct monthly federal and state exclusion and sanction screenings to identify potential compliance risks and protect your practice.
Medicaid Risk-Based Screening
New Requirement
Medicaid assigns providers risk categories, with higher-risk classifications potentially requiring site visits and fingerprint-based background checks.
Our Response
We prepare supporting documentation according to each provider’s risk level, helping reduce delays during enrollment and screening.
Compliance Built into Every File
Credentialing errors surface as claim denials, audit findings, and payer terminations. Our medical insurance credentialing process applies quality controls to every application.
Checks We Apply Before Submission
- Licenses, DEA, and board certifications verified with expiration dates.
- NPI, taxonomy, and practice locations matched across records.
- Malpractice coverage limits checked against payer-specific minimum requirements.
- Signatures, dates, and attestation fields reviewed for completeness.
- Sanction and exclusion screenings completed, verified, and documented thoroughly.
What You Receive
- Credentialing tracker displaying every provider and payer status.
- Expiration alerts issued 120 days before upcoming renewals.
- Complete, audit-ready credentialing files maintained for every provider.
- Monthly summaries covering approvals, pending items, and potential risks.
The Resilient MBS Difference: Accuracy You Can Measure
Every coder on our team holds a nationally recognized credential (CPC, COC, CCS, CCS-P, CRC, or CIC), is matched to your specialty, and has every claim reviewed through layered quality checks. We hold our coders to a 95%+ documented accuracy standard, verified through continuous audits.
| Typical Coding Vendor | Resilient MBS | |
|---|---|---|
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Application Review
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Submitted as received
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Pre-audited for gaps and mismatches
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Payer follow-up
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Occasional status checks
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Weekly tracking with documented escalation
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Data Profile Upkeep
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Left to the practice
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Managed and re-attested on schedule
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Revalidation Tracking
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Manual or missed
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Calendar alerts well before deadlines
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Effective-date Confirmation |
Often skipped
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Verified before billing begins
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Exclusion Monitoring
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One-time
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Monthly checks
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Reporting
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On request |
Live tracker plus monthly summary
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Account Contact
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Rotating staff
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Dedicated credentialing specialist
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Credentialing Solutions for Every Healthcare Provider
Our doctor credentialing services adapt to each organization’s size, structure, and payer mix.
Mid-Sized Medical Practices
Group enrollment, new-hire onboarding, and roster management for practices of 10 to 50 providers that ensure updated operations and compliance.
Hospitals and Health Systems
Our hospital credentialing services cover medical staff appointments, privileging support, and payer enrollment for employed and affiliated physicians.
Specialty Groups
Cardiology, orthopedics, behavioral health, radiology, and anesthesia, each with its own contracting and needs of certification and compliance.
Telehealth and Multi-State Providers
Multi-state licensing support that includes expedited pathways in states that participate in interstate licensure compacts and payer enrollment of each state.
State Rules Change the Credentialing Timeline
The same provider can face very different requirements depending on the state. We build each application around local rules.
State Medicaid Programs
Each program has its own portal, forms, and processing times, and many require separate enrollment for managed care plans.
Licensure Compacts
More than 40 states participate in the physician licensure compact, and a similar compact exists for nurses and that minimize repeat paperwork.
Scope of Practice Differences
Nurse practitioners and physician assistants face different supervision and prescribing rules by state, which affects how payers classify them.
Credentialing Time Limits
Some states set maximum payer response windows for credentialing applications. We use these to hold payers accountable on stalled files.
FAQs
Credentialing is an important step for determining the credentials of a practitioner including education, licenses, certifications, training and experience. Payer enrollment is where the practitioner is enrolled within an insurance network so that they can be billed for their services. Both processes can be handled by us.
Of course! We analyze your existing profiles, credentials, and any outstanding applications to spot any gaps in your information, any out-of-date documents, and any data mismatches. Our staff will resolve discrepancies, manage your records, and continue your management without duplicating efforts or creating additional delays for your organization.
We analyze each case of denial or delay to determine the reason behind the same, which may be non-availability of documentation, wrong information, or the closure of provider panels. Our staff resolves the problem, re-submits the application forms, and contacts the representative of the payer for resolution of the problem.
We have been monitoring the dates when providers’ renewals should take place along with payer-specific requirements and re-validation of their credentials ahead of time. This ensures that our records stay up to date by handling recurrent attestation processes, collecting necessary documents, and applying for renewals ahead of time.
We ensure that the data security of the providers is taken care of through access control system, security of documents, and limited information sharing. Information sharing is done with the persons who are allowed and have any part to play in the process of enrollment.
Put Your Providers in Network Without the Wait
Speak with a Resilient MBS credentialing specialist and receive a custom enrollment plan for your practice.
