Enterprise Outsourcing for Urgent Care Networks and Multi-Site Urgent Care Groups

Our credentialing pod runs CAQH ProView maintenance, NPPES updates, primary source verification, state license checks, DEA verification, and re-credentialing cycles across Medicare, Medicaid by state, commercial payers, and workers comp carriers per clinic. Urgent care credentialing is uniquely time-pressured because walk-in volume arrives from day one with every payer card in the market. Commercial payer enrollment averages 90 to 120 days and Medicare through PECOS runs 60 to 90 days, so we run applications in parallel across all clinics and surface enrollment gaps before they turn into denied claims. PayerReady estimates an uncredentialed urgent care provider costs about $5,075 per day in lost revenue.

Yes. We sign a single Business Associate Agreement at the urgent care network level with a schedule of covered clinics. New sites added mid-engagement are appended through a short addendum, not a fresh BAA. This mirrors the contracting workflow urgent care networks already run with payers and clearinghouses. Staffingly is SOC 2 Type II audited, HITRUST-aligned, and ISO 27001-aligned.

Yes. Our AAPC-credentialed coders work standard urgent care E/M codes 99202 to 99215 plus the urgent care HCPCS S-codes: S9083 (the global, all-inclusive urgent care fee some payers require) and S9088 (services provided in an urgent care center, billed in addition to an E/M code). Reimbursement for S9088 varies by payer, some treat it as informational only and Medicare does not reimburse it, so we bill it only where payer contracts and state rules allow. For workers comp and occupational medicine, we handle employer versus payer split billing, state workers comp fee schedules, authorization for follow-up visits, and the documentation occ-med carriers require.

Urgent care volume spikes in the evenings, on weekends, and during cold and flu season, which is exactly when fixed front-desk headcount runs short. Our remote virtual medical assistants extend coverage from early morning through late evening across US time zones for inbound calls, appointment and queue management in Solv, eligibility checks, and patient callbacks. You scale seats up for the busy season and back down after, billed by the FTE per week, instead of carrying year-round overstaffing.

Hourly, by the FTE, billed weekly. Three tiers: Single at $399 per week for one dedicated specialist at a single clinic, Team at $349 per week for 5+ specialists across credentialing, eligibility, workers comp billing, RCM, and after-hours VMA, and Enterprise at $299 per week for multi-site urgent care networks or PE-backed groups. No 7-year contracts, no percent-of-collections pricing, no minimums beyond the 2-Week Risk-Free Pilot. Estimated cost savings are based on US Bureau of Labor Statistics wage data for front-office staff, medical billers, and credentialing specialists.

Yes. Our specialists are fluent across Experity, the purpose-built urgent care platform that roughly half of US urgent care centers run, plus eClinicalWorks, athenahealth, NextGen, Epic, Tebra, AdvancedMD, Solv for scheduling and queue management, and Waystar for clearinghouse and claims. We also operate inside client-proprietary tools when a network has built its own. After acquisitions, a single urgent care group often runs several of these at once, and our team logs into each one your way.

Industry data shows 41 percent of providers now report denial rates above 10 percent, against a healthy benchmark of 5 to 10 percent, and reworking a single denied claim costs $25 to $181 while 65 percent of denials are never reworked at all. We attack denials upstream with real-time eligibility, clean coding on E/M and S-codes, and prior authorization before the visit, then work the denials that do land, group them by reason code, and refile clean. About 9 percent of denials trace to a missing prior authorization or referral, which is preventable with the right front-end checks.

Standard urgent care acquisitions are absorbed through a BAA addendum and a new scope-per-clinic exhibit. We have onboarded sites inside a 7-day window when the existing network contract architecture is already in place. The acquired clinic keeps its own EHR and payer mix; we add coverage without disturbing your other locations. The first weekly scorecard the acquired clinic appears on includes credentialing status, eligibility hit rate, denial rate, workers comp turnaround, and AR aging from day one of go-live.

Yes. Urgent care still generates prior authorization work for advanced imaging, specialty referrals, and certain injectables. The AMA reports physicians and staff spend about 13 hours per week on prior authorization, and CMS-0057-F now requires impacted payers, Medicare Advantage, Medicaid managed care, CHIP, and qualified health plans on the federal exchanges, to speed up and report PA decisions. Our PA pod submits, tracks decision-time SLAs, and surfaces approvals before the follow-up visit so the patient is not stuck waiting.

Our multi-state credentialing pod runs CAQH ProView maintenance, NPPES updates, primary source verification, state license verification, DEA checks, state Medicaid enrollment, and commercial and workers comp payer applications in parallel across all target states. Typical timeline: 48 to 72 hours to deploy the credentialing team, 30 to 45 days to first approval per payer per state for a clean file, and 60 to 90 days to fully active panels network-wide. About 85 percent of enrollment delays trace to incomplete or inaccurate provider data, so our file-readiness checks front-load the work that usually stalls applications.