CREDENTIALING SERVICES
Get your providers cleared to bill - faster
Tech-enabled, compliance-first credentialing for behavioral-health and clinic practices - verified, enrolled and monitored so a credentialing gap never becomes a revenue gap.
Fail-closed
No clearance, no billing
8 types
NCQA primary-source
90/60/30
Expirables safety net
Dr. A. Okafor · LPC
PSV complete · CAQH attested
Dr. M. Reyes · MD
Payer enrollment · Day 30 follow-up
Dr. J. Lin · PMHNP
License expirable · 30-day escalation
The problem
Credentialing is where revenue quietly leaks
The work is done - but until enrollment is approved, none of it is billable.
90–120days
Typical payer-enrollment clock
The payer-enrollment clock for a single provider - every week of delay is unbillable care.
45–90extra days
One transposed digit
A single wrong digit on an SSN, NPI or TIN gets the application rejected and sent to the back of the line.
$0billable
Until enrollment approves
A provider can collect nothing until enrollment is approved - the work is done, but the revenue is not.
What is at stake
Get it wrong, and the costs compound
Denied & unbillable claims
Care delivered before enrollment is approved is written off - or fights through appeals for months.
Suspended billing privileges
A lapsed license, DEA or malpractice policy automatically suspends Medicare and commercial billing - overnight.
Sanctions & exclusion exposure
Billing for an OIG/SAM-excluded provider triggers repayment demands and federal penalties per claim.
Our approach
Tech-enabled human credentialing
We pair an enterprise credentialing platform with specialists who verify every result against the primary source. Automation moves fast; humans make sure it is right.
Platform does the heavy lifting
Automated OIG/SAM screening, state-board & DEA verification, board-cert and NPI checks, and 90-day expiration alerts - instant, timestamped, audit-ready.
Experts own the outcome
A specialist builds the file, verifies every source, drafts and submits payer applications, and chases approval - under strict Maker-Checker QA.
THE ENGINE BEHIND THE PERFORMANCE
Reliability we engineer with CQI, not just automation
Our speed and our zero-lapse record are not just automation. They come from a Continuous Quality Improvement model embedded in every file. The platform and our specialists move fast, but it is CQI that finds the recurring cause behind a delay and engineers it out, so the next provider moves faster still.
Measure
Turnaround, follow-up cadence and expirables tracked per provider, in real time.
Diagnose
We find the recurring cause behind a stalled application or a missed renewal.
Improve
We redesign intake and follow-up so the same delay cannot recur.
Sustain
The improved standard is locked in and monitored across your whole roster.
and the cycle repeats, continuously, on your dashboard
A partner, not a vendor
We treat a stuck application as our problem to solve, not a status to report. Owning the bottleneck, and the outcome, is the support above and beyond that makes us a partner rather than a vendor.
WATCH
See how we get providers cleared to bill
HOW IT WORKS
From intake to cleared to bill
Secure intake
Zero-Defect collection via a secure provider link - the clock starts only at a 100% complete file.
Primary-source verification
Every credential verified at the source with immutable, timestamped proof (NCQA 180-day rule).
Payer enrollment
CAQH, PECOS, commercial and Medicaid applications drafted, QA-checked and submitted.
Relentless follow-up
Structured payer chasing on Days 15, 30 and 45+ until the billing effective date is secured.
Clearance to Bill
The green light that lets billing begin - with nothing slipping through.
Ongoing monitoring
Continuous OIG/SAM sweeps and 90/60/30-day expirables alerts keep every file billable.
Built to protect you
No clearance, no billing
Our process fails closed: a provider cannot be billed until a verified Clearance to Bill exists - so a gap never quietly becomes a clawback.
Hard-stop gate
Billing is blocked the moment clearance, a license or malpractice coverage lapses.
Kill Switch
A confirmed OIG/SAM exclusion halts all work instantly and escalates within the hour.
Maker-Checker QA
No application is ever submitted without an independent second reviewer's sign-off.
Fail-closed by design. The same rule that protects patients protects your revenue cycle - a provider who is not verified simply cannot be billed.
Compliance built in
Audit-ready, every day
NCQA 180-day rule
Every verification carries an immutable source URL and timestamp - no stale or undocumented checks.
OIG / SAM monitoring
Monthly exclusion screening of your full roster, with email alerts on any positive hit.
NPDB & sanctions
One-time and continuous NPDB queries surface malpractice, license actions and restrictions.
TJC privileging
FPPE/OPPE tracking and standardized privilege delineation for facility and hospital clients.
NEVER MISS A RENEWAL
The 90 / 60 / 30 safety net
Every license, DEA, board certification and malpractice policy is tracked to its expiration date - escalating reminders fire automatically.
90 days out
Polite provider reminder - renewal begins early, with plenty of runway.
60 days out
Follow-up and tracking - status confirmed against the primary source.
30 days out
Urgent escalation - Clinic Administrator and Medical Director looped in, same-day call.
Speed you can plan around
A clock that actually starts
The timer starts at a complete file
The SLA begins the moment a 100% verified intake packet is received - no more guessing.
Relentless payer follow-up
Documented chasing on Days 15, 30 and 45+ keeps your applications moving through the queue.
As fast as two weeks
With clearance and the BAA in place, providers can be billing in as little as two weeks.
96 hours, intake to submitted - during our pilot. Internal processing took providers from a complete file to drafted, QA-passed and submitted in 96 hours during our pilot cohort. This is an early benchmark, not a guaranteed turnaround.
TRANSPARENCY & TRUST
You always know where you stand
Your own client portal
A single dashboard per clinic shows live credentialing and enrollment status for every provider.
Proactive status updates
Weekly status reporting and alerts - no chasing us for where an application sits.
Zero-Trust security
HIPAA-aligned, MFA-protected, no-local-data infrastructure. PHI is encrypted end to end.
BAA before anything
"No BAA, No Access" - no provider data moves until the agreement is executed.
Why NexCQISolutions
In-house vs. generic vendor vs. us
| Capability | In-house | Generic vendor | NexCQISolutions |
|---|---|---|---|
| Behavioral-health focus | Limited | Rare | Built for it |
| Fail-closed Clearance-to-Bill | |||
| Automated OIG/SAM + expirables | Manual | Basic | |
| One owner, intake to monitoring | |||
| Live transparency portal | Limited | ||
| Maker-Checker QA on every file | Varies | Rare |
How you buy it
Standalone or fully integrated
Credentialing is fully standalone - it needs no EMR or billing. Or bundle it with EMR and revenue cycle under one team and one portal.
SERVICE
Revenue cycle management
Certified coders turn cleared providers into clean, defensible reimbursement.
Explore RCM →
SERVICE
NexCQISolutions EMR
An EMR that enforces the credentialing hard-stop automatically.
Explore the EMR →
BEST VALUE
All-In-One Advantage
Credentialing + EMR + revenue cycle, one team and one portal.
See the Advantage →
Let's get your providers cleared to bill
Pricing is per provider and tailored to your roster - book a 30-minute call and we'll map your path to billing.