Count pairs, not providers
The real unit
- 1,682 pairs, 23.5 per provider
- 97.8% billable somewhere, 0% everywhere
Home / Case studies / Credentialing
Case study · Service outcome, credentialing
Credentialing hold AR from $1.03M to about $170K in four months, and the $277K that names the leak
Short answer: a health center with 89 providers, 2,094 enrollments and 91 payers. The credentialing team, working in CredPro, took the hold queue from $1,034,797 to about $170K, June to October 2026, and adjusted off $276,644 billed under never-enrolled providers. What the software alone caused is not claimed.
1,682 provider-payer pairs
97.8% billable somewhere · 0% active everywhere
P90 start to effective · 400 days
Roll-forward closes within 0.25%
Edition
Case study · Oct 2026
Archetype
Health center · 89 providers
Payers
91 · 2,094 enrollments
Metric
Credentialing hold AR
Horizon
Jun to Oct 2026
Length
5 min read
$1.03Mto ~$170K
Claims held for credentialing, at go-live in June and in October 2026
ASP-RCM engagement records$276,644adjusted
Services billed under providers not yet enrolled: the leak the enrollments stop
ASP-RCM engagement records400days, P90
Enrollment start to effective date on the day-one book; median 62.5, mean 150
ASP-RCM engagement records326overdue
Recredentialings already overdue on June 25, 2026, with 113 more due within 90 days
ASP-RCM engagement records$1,034,797 to about $170K, date by date
Claims held for credentialing, by date
August 11 was the last published point; October is new. ASP-RCM engagement records.
$1,034,797go-live, 100%Junego-live
$904,561-13% vs go-liveJun 27-$130,236
$679K-34% vs go-liveAug 3-$356K
$647K-37% vs go-liveAug 11-$388K
~$170K-84% vs go-liveOctoberabout
Go-live queuePublished checkpointsOctober, new point
Billable somewhere, active nowhere
June 25, 2026: 89 providers, 2,094 enrollments, 91 payers, 7 centers, 1,682 provider-payer pairs. Every visit by a provider on the wrong side of the gap became a held claim.
Status of 1,682 provider-payer pairs, and how long an enrollment took
Diagnostic, June 25, 2026.
Active pairs65.1% of 1,682
1,09565.1%
Recredentialing18.5%
31118.5%
Still enrolling11.4%
19211.4%
025%50%65% of pairs
Start to effective date, medianmedian
62.5 days16% of the P90
Start to effective date, meanmean
150 days38% of the P90
Start to effective date, P90P90
400 days100%, the tail
0100200300400 days
Active pairs and turnaroundPairs not yet billableThe P90 tail
What the queue was made of, measured before any work
| Measure | Day-one value | Read |
|---|---|---|
| Recredentialings overdue | 326, with 113 more due within 90 days | A lapse becomes a new held claim |
| Open items older than 90 days | 643 of 694 92.7% | Nothing fresh |
| Providers billable with at least one payer | 97.8% | Looks healthy |
| Providers active with every payer they see | 0% | Explains $1.03M held |
Six dates, June to October 2026
- 125 Jun 2026Day-one book: 1,682 pairs, 326 recreds overdue, P90 400 days
- 227 JunHold queue $904,561, down 13% from go-live
- 3JulyCO-8 on the encounter code traced to credentialing
- 43 AugHold queue $679K, down 34%
- 530 SepRoll-forward closes within $10,605; $276,644 adjusted
- 6OctoberHold queue about $170K
Release held claims
Held claims released as each effective date arrived
Recred backlog
326 overdue recredentialings worked first
CO-8 relabel
Encounter-code denials re-routed
Adjust honestly
$276,644 adjusted, 4%
Hold queue worked against effective datesBacklog and adjustmentsDenial relabel
Not every held dollar is collectible
Billed under providers not enrolled on the date of service, not enrollable retroactively: 4% of the AR reduction.
Unexplained in the roll-forward: $10,605, 0.25%.
Same lesson, different code
CO-8 denials on the health center's encounter code had been logged as coding errors. They were credentialing failures: the rendering provider's taxonomy or enrollment did not match the payer's file. Relabeling them moved the work to the team that could fix it.
Five moves inside CredPro, and what each one changed
The outcome is real; the software's share is not proven. These are the team's moves inside CredPro.
StepWhat the team didWhat it changed
01
Measure the pairs, not the providers1,682 pairs tracked individually
Changed"Billable somewhere" stopped counting as done
02
Work the hold queue against effective datesEach held claim linked to the enrollment that blocked it
ChangedReleased the week the payer's effective date arrived
03
Clear the recredentialing backlog first326 overdue recreds, a second leak in waiting
ChangedNo new held claims from lapsed active providers
04
Adjust honestlyServices billed before enrollment and past the retroactive window
Changed$276,644 adjusted rather than left to age as if collectible
05
Relabel CO-8Encounter-code denials re-routed from coding
ChangedDenial categories now name the owner, not the symptom
Platform facts, not client outcomes
| Platform fact | Value | Note |
|---|---|---|
| Payer enrollment registry | 85 portals, 51 Medicaid, 16 state-mandated | Plus 9 fillable payer PDFs |
| Form auto-fill from one provider record | 182 of 231 mapped fields 78.8% | Measured on a demo provider |
| Exclusion screening source | 84,001 OIG exclusion records loaded | Checked against every provider |
| Scale on a live client restore | 4,106 work items, 545 providers, 11,907 notes | Platform scale, not an outcome |
Four things this book teaches
The tail holds the money
Turnaround
- Median 62.5 days looked fine
- P90 400 days is where $1.03M sat
A lapse is the next leak
Recredentialing
- 326 overdue, 113 due in 90 days
- Worked before new enrollments
Name the owner, not the symptom
Denials
- CO-8 on the encounter code was credentialing
- Relabeled, it reached the right team
Takeaway
Billable with one payer and unenrolled with the rest is a held claim waiting to happen. Measure the pairs, work the effective dates, adjust what was never collectible.
Four things we will not claim until they are measured
- ToolTool attributionThe queue fell while the team worked in CredPro. Software versus people is not isolated, so we do not say "CredPro cut the queue".
- TATTurnaround timeDay one: median 62.5 days, P90 400. Post go-live enrollments are not yet measured, so no improvement is claimed.
- $170KThe last $170KPart pending with payers, part future adjustments like the $276,644. Split not final.
- 326Recredentialing cadence326 overdue worked; staying current through the next cycle is the real test.
Frequently asked questions
What is credentialing hold AR?
Claims a billing system returns or holds because the rendering provider was not enrolled, or not linked correctly, with the payer on the date of service. On this book that queue was $1,034,797 at go-live in June 2026 and about $170K by October.
Did CredPro produce the result?
The credentialing team produced it while working in CredPro. We have not isolated how much the software contributed versus the people, so the page describes the service outcome and labels the platform figures separately.
Why was $276,644 adjusted off?
Those services were billed under providers who were not enrolled with the payer on the date of service and could not be enrolled retroactively. Adjusting them was honest accounting; the enrollment work is what stops the next $276,644.
What did the day-one book look like?
89 providers, 2,094 enrollments, 91 payers and 1,682 provider-payer pairs. 97.8 percent of providers were billable with at least one payer and 0 percent were active with every payer they saw. 326 recredentialings were overdue and the 90th-percentile time from start to effective date was 400 days.
- 42 CFR 438.602: State responsibilities, including screening and enrollment of Medicaid managed care network providers
- 42 CFR 424.521: Request for payment by certain provider and supplier types (retrospective billing limits)
- HHS Office of Inspector General: Exclusions program and List of Excluded Individuals/Entities
Checked October 25, 2026. Engagement figures are from ASP-RCM records for the periods stated; rules change, confirm against the source before relying on them.
ServiceMedical credentialing services
ServicePayer enrollment and contract negotiation
ServiceFQHC billing services
Case studyThe same book at day 60
Case studyFront-end encounter leak, first 70 days
Case studyHealth center four-month AR turnaround
Case studyUrgent care credentialing gap and declined panels
Case studyRecredentialing PSV checklist
Find out how much of your AR is waiting on enrollment
We measure your provider-payer pairs, the hold queue they create, the overdue recredentialings and the dollars billed before enrollment, and show the split before any work starts.