Provider Enrollment Case Study: Claims Resolved in 60 Days

How Lister Turned Claim Rejections into Successful Reimbursements in Just 60 Days

Client Background

A growing U.S.-based urgent care center partnered with Lister to strengthen its Revenue Cycle Management operations and improve reimbursement performance.

At the time of onboarding, the center operated with multiple rendering providers, including Physician Assistants (PAs), under an existing group payer contract.

However, shortly after claims submission began, the center experienced a significant rise in claim rejections from a major insurance payer.

The Challenge

The issue surfaced when claims began getting rejected due to provider enrollment discrepancies.

Root Cause Identified

After detailed payer follow-up and eligibility investigation, Lister identified that:

The urgent care center held an active group contract with the payer.
Only the lead physician was properly linked to the payer contract.
The Physician Assistants and additional rendering providers were not enrolled or associated with the group contract.
As a result, claims submitted under those provider NPIs were automatically rejected.

Without rapid intervention, the center faced:

Delayed reimbursements.
Growing accounts receivable.
Increased administrative burden.
Potential compliance concerns.

Lister’s Approach

1. Immediate Investigation & Payer Coordination

Lister’s RCM and credentialing teams immediately escalated the issue and coordinated directly with the payer to validate enrollment status and determine corrective actions.

During the review, Lister identified that the payer offered access through a multi-payer provider portal, enabling provider-group linkage management through the “Payer Space” functionality.

This discovery became the turning point in resolving the issue quickly.

2. Credentialing & Provider Linking Support

Lister worked closely with the urgent care center to obtain required provider documentation and CAQH information for each rendering provider.

Actions Completed:

Lister requested center to retrieve the provider CAQH profile and share it with
us to fix the credential issue.
With the help of the CAQH profile details provided by center, Lister submitted credentialing applications through the multi-payer provider portal.
Linked individual providers to the existing group payer contract.
Coordinated follow-ups with the payer until approvals were finalized.

Why CAQH Matters

CAQH allows providers to securely maintain:

Demographic information.
Licensure details.
Education history.
Work history.
Credentialing documentation.

This centralized process significantly reduces repetitive payer enrollment work and accelerates provider onboarding.

Results Achieved Within Two Months

LOperational & Financial Outcomes

Claims successfully transitioned to billing under individual rendering providers.
Payments began flowing correctly post credentialing approval.
Denials related to provider enrollment were significantly reduced post credentialing approval.
The urgent care center gained a scalable provider onboarding workflow.

Credentialing Progress

Credentialing completed for 3 providers.
2 providers pending CAQH completion.
175 historical claims identified and strategically managed for dates of service prior to provider effective dates.

Key Impact Delivered by Lister

Faster Problem Identification

Lister identified the true denial root cause beyond standard rejection codes.

End-to-End Credentialing Support

From CAQH coordination to payer follow-up, Lister managed the complete enrollment process.

Revenue Preservation

Implemented interim billing workflows that protected cash flow while maintaining compliance awareness.

Operational Visibility

Provided the client with clear payer enrollment tracking and credentialing status updates.

Conclusion

What initially appeared to be a standard denial issue was actually a payer enrollment and provider linkage gap that threatened reimbursement continuity.

By combining deep payer knowledge, credentialing expertise, and proactive RCM execution, Lister helped the urgent care center rapidly restore claims flow, recover payments, and establish a stronger billing foundation for future growth.

Within just two months of partnership, the center transitioned from recurring provider enrollment denials to successful provider-level reimbursements and a more scalable revenue cycle process.

Recurring claim rejections are rarely just billing problems—they’re often symptoms of deeper payer enrollment or credentialing issues. Lister combines credentialing expertise with hands-on revenue cycle management to identify the underlying cause, resolve reimbursement barriers quickly, and establish scalable processes that support future growth. If provider enrollment issues are slowing payments at your practice, we’ll help you restore cash flow and prevent similar problems from recurring.

Why Healthcare Providers Choose Lister?

20+ years as Trusted RCM Partner.
5 M+ claims in Urgent Care, Primary Care & Family Practice.
98% First Pass Acceptance Rate.
<5% Initial Claim Denial Rate.
<10% Over 90 Days AR.
Working with one of the largest Urgent Care Brands in the US.
HIPAA Compliant & Secure processes.

Let's Find the Revenue You're Missing

Whether you’re looking to reduce aged A/R, improve reimbursement, recover unpaid claims, or strengthen your entire revenue cycle, our specialists are ready to help.

Complete the form below to schedule your complimentary Revenue Leakage Assessment (Worth $750) and discover practical opportunities to improve your financial performance.