What to expect, 2 of 7Read this once your Monday email says applications were submitted.
Your applications are out. What to expect.
How long each payer takes, what we do while you wait, the four things only you can do, and what approval looks like.
We filed one application per payer per clinician, under your practice (your EIN and Type 2 NPI) unless you asked for individual contracts. Each one has a case or reference number. From here the payer sets the pace; we keep it moving and tell you every Monday where each one stands.
How long it takes
We quote 60 to 90 days because that is what most payers have taken for the practices we file for. Some are faster, some are slower, and the same payer varies by state and by month.
Aetna, Cigna, UHC, national BCBS plans
What we usually see: 30 to 90 days
Notes: Recent examples: Aetna about 30 days, BCBS about 45. Cigna and Evernorth can take the full 90.
Medicare
What we usually see: About 35 days
Notes: Original Medicare. Needs the voided check and a bank account in the exact name on your EIN letter (or your own name if you enroll as an individual). Medicare Advantage plans are separate applications with each commercial payer.
Medicaid
What we usually see: Up to about six months
Notes: A separate application in every state, with more back-and-forth. In most states a managed Medicaid plan (MCO) will not finish until your state Medicaid enrollment is active, so we file Medicaid first and tell you what can run in parallel.
Regional plans and EAPs
What we usually see: Varies
Notes: Some need their own forms, a W-9 certification, or a group roster first. We tell you which.
A payer that is not accepting providers
What we usually see: Waitlisted
Notes: Some payers keep a waitlist, others just say closed. Either way we tell you, re-check about every two months, and re-apply when it opens. You can swap in another payer meanwhile.
What we do while you wait
- 1
Confirm receipt early
Within the first couple of weeks we confirm each payer has the application and nothing is missing from it.
- 2
Chase around day 40
If a payer has gone quiet, we call and get a status and a reference. We log every call so the Monday email can say exactly what the payer said.
- 3
Work every missing-information request
Payers ask for things mid-stream: a wrong packet type, a taxonomy change, a signature, a roster spreadsheet. We handle what we can and send you only what needs you.
- 4
Report every Monday
The Credentialing updates section of your Monday email lists each payer: submitted, pending, info needed, approved with effective date, or blocked and what unblocks it. The same list is on the Credentials page in Bomi EHR or the portal.
The four things only you can do
Each of these has stalled an application for weeks when it sat in an inbox. When one comes up, the same day is ideal and the same week keeps you on schedule.
- Forward payer contracts the day they arrive. We flag the rate, the terms, and the signing deadline, then you sign. Windows are often short, and your effective date usually starts at countersignature.
- Approve portal access and two-factor codes. Availity, Provider Express (Optum), and some payer portals send a code or an approval request to the authorized signer. That is you.
- Answer identity and ownership questions. Medicare and Medicaid ask about owners, prior names, and addresses. We draft; you confirm.
- Keep your license and malpractice current. A policy that lapses mid-review gets the application kicked back. We remind you a month before anything expires.
What approval looks like
- 1
The payer sends a contract or welcome letter with an effective date
Sometimes to you, sometimes to us. Forward anything a payer mails or emails you; we tell you what, if anything, needs a decision from you, including the rate in the contract before you sign it.
- 2
We confirm the effective date and load the payer
We check the contract loaded correctly on the payer side (a common failure when an old group link is still attached to your NPI), load the payer ID into your EHR, and request direct deposit and electronic remittance (ERA) with that payer.
- 3
Then you see insurance clients for that payer
Wait for the written effective date in your Monday email before scheduling insurance sessions for that payer. Most commercial payers will not cover sessions before it; Medicare sometimes allows a short look-back, and we tell you when that applies.
- 4
Move one client first
Bill one session, watch it pay, then move the rest. This is the same one-client test we recommend to practices leaving a platform.
Questions we get during the wait
- Can I speed it up by calling the payer myself?
- Usually not. Tell us what you want to know and we will get it on our next call, so the payer hears one consistent story. If a payer calls you directly, take the call and forward us the details.
- A payer told me I am approved but the Monday email still says pending.
- Approval in a phone call and a loaded contract with an effective date are different things. We wait for the written effective date before we call it done, because claims before that date deny.
- What do the rates look like?
- Your contract sets them, and we do not estimate before the payer sends it. Once you are in, we go back to each payer once a year and try to negotiate.
- Do I pay anything during this stretch?
- Your first four applications are included. Applications beyond that are $50 per payer per clinician. The 4% billing fee does not start until we start billing.
- What happens after I am in?
- We keep it current: CAQH attestations, directory attestations, and roster updates. Commercial payers re-credential about every three years and Medicare revalidates every five; we ask first, then handle it ($50 per payer per clinician). Your malpractice and license renewals get a reminder a month ahead.