See What Credentialing Delays Are Actually Costing You
eClinicalWorks can flag a provider's credentialing status as pending. It has no idea that pending status carries a dollar figure, and it won't tell you whether that revenue is still recoverable or already gone.
Medicare allows retroactive billing up to 30 days before a provider's enrollment date, but only under specific circumstances. Commercial payers usually don't allow it at all. This calculator applies the real rule by payer type, then does the math: recoverable revenue against what's genuinely at risk.
What’s Inside This Tracker?
One workbook, four tabs: the real Medicare retroactive billing rule, a place to log every provider-payer gap, and the dollar math already done for you.
1. Retroactive Billing Rules Reference
- Medicare's actual 30-day retroactive window is built in, sourced from 42 CFR 424.521(a)
- Medicare Advantage, Medicaid, and commercial payers default to zero days, since retroactive billing isn't automatic for any of them
- Every default is editable the moment you confirm a specific payer's real terms
- No guessing which rule applies where; the reference table already knows
2. Credentialing Data Input
- Provider start date, application date, and payer effective date get entered once per provider-payer pair
- The gap between start date and effective date calculates on its own
- Confirm retroactive billing case by case, since Medicare's rule only applies when circumstances call for it, not automatically
- Average daily visit volume and revenue per visit turn that gap into an actual dollar figure
3. Revenue Impact Summary
- Every provider's total exposure rolls up automatically across all of their payers
- An adjustable dollar threshold flags which providers are worth escalating this week
- Providers rank by revenue at risk, highest first, not alphabetically
- One view for the whole practice instead of a separate spreadsheet per provider
Built for Healthcare Leaders Responsible for Credentialing & Revenue Cycle Oversight
Created for the leaders who want to stop credentialing delay after the revenue has already gone missing, not before.
