This administrator SOP covers moving a provider through the Provider Pipeline and maintaining payer credentialing without advancing a status before the required evidence exists. The pipeline shows overall onboarding progress; credentialing tracks payer-specific work.



 

📚 Resources Needed

  • Provider Pipeline
  • Insurance Tracker
  • Provider application, forms, documents, NPI, CAQH, license, DEA information when applicable, payer reference numbers, and follow-up evidence

 

✅ Before You Start

  • Confirm you are in the Administrator view and have the correct provider’s full name and email.
  • Search the pipeline before creating or editing a provider.
  • Review the provider’s Profile & Forms and Documents before advancing any dependent onboarding or credentialing step.
  • Use verified payer communication for submitted date, reference number, effective date, renewal date, and notes.

⚠️ A credentialing status is an operational assertion. Do not advance it because work is expected or verbally discussed; advance it when the corresponding submission, payer activity, or completion evidence exists.

 

🚀 Tips & Tricks

  • Use pipeline filters to narrow All, Onboarding, Processing, or Active, then search by provider name.
  • Keep internal notes specific: what happened, who owns the next action, and when follow-up is due.
  • Use Quick Copy Credentials only after comparing NPI, CAQH, License, DEA, and SSN indicators to the underlying profile.
  • Update credentialing in either the provider detail or Insurance Tracker, then confirm the change appears in both places.

 

📘 Part 1 — Review the Provider Pipeline

  1. Open Administration → Provider Pipeline.
  2. Select the appropriate filter: Onboarding for early provider tasks, Processing for active administration work, or Active for completed onboarding.
  3. Search the provider’s full name. Open the exact matching provider.
  4. Review the provider summary and tabs: Onboarding, Profile & Forms, Documents, Credentialing, and Communication.
  5. Under Profile & Forms, verify submitted answers or enter a previously completed approved form when the provider joined before the portal.
  6. Under Documents, confirm required files are present, readable, assigned to the correct type, and have expiration dates when applicable.
  7. Under Onboarding, review each step’s owner and evidence. Unlock a provider step only when prerequisites are satisfied. Mark an administrator review complete only after verification.
  8. Add an internal note describing any blocker, next action, owner, and follow-up date.

Provider Portal administrator navigation

 

📘 Part 2 — Update Insurance Credentialing

  1. Open Insurance Tracker or the provider’s Credentialing tab.
  2. Review Group Level Enrollment first. Confirm the payer exists and the group contract, Group NPI submitted date, effective date, renewal date, contact, and notes are current.
  3. Under Per-Provider Credentialing, locate the provider and payer.
  4. Advance status only in the order displayed by the portal: Not Started → Pending → In Progress → Done.
  5. Record the submitted date and reference number when the application is transmitted. Add the payer contact and a concise note about follow-up.
  6. Set Done only when the payer outcome is confirmed. Add effective and renewal information where the workflow provides it.
  7. Return to the provider detail and confirm the Credentialing table shows the same payer, status, submitted date, reference number, and notes.
  8. If the provider must act, send a portal Message that names the missing item and deadline without exposing sensitive information unnecessarily.

 

📊 Status Guide

StatusMeaningRequired EvidenceNext Action
Not StartedNo payer-specific submission work has begun.Provider and group prerequisites may still be incomplete.Confirm prerequisites and assign the task.
PendingThe item is queued or waiting for information before active processing.Documented owner and missing requirement.Obtain the missing information and set follow-up.
In ProgressSubmission or payer follow-up is actively underway.Submitted date, payer contact, reference number, or comparable activity.Continue follow-up and maintain notes.
DoneCredentialing is confirmed complete for that provider/payer.Confirmed payer outcome and applicable effective date.Monitor renewal or revalidation.

 

⚠️ Exceptions and Corrections

The provider is not in the pipeline

Search by full name and email and clear filters. If the provider truly does not exist, follow the approved provider-invite process. Do not create a duplicate from a spelling variation.

The payer is missing

Confirm the payer should be part of group enrollment. Adding a payer at the group level creates rows for every provider, so verify the organizational decision before adding it.

A status was advanced incorrectly

Correct it immediately if the portal permits and add an internal note explaining the correction. If history cannot be corrected safely, submit Support with the provider, payer, incorrect status, correct status, and evidence reference.

 

🛠 Troubleshooting

  • If search returns no providers, clear the active filter and search only the last name.
  • If documents are present but a step remains blocked, confirm the document type and required expiration fields.
  • If a status differs between Provider Detail and Insurance Tracker, refresh both once and stop further changes until the inconsistency is resolved.
  • If the provider says a step is complete but the portal shows a clock, verify whether the item is waiting on administrator review.

 

✅ Completion Check

  • The correct provider record was updated.
  • Pipeline progress matches verified forms, documents, and admin reviews.
  • Each payer status has enough evidence to support its state.
  • Submitted, effective, renewal, reference, contact, and notes are recorded when applicable.
  • Provider Detail and Insurance Tracker agree after refresh.

 

If you have any questions, something does not match what you see, or you need more information, please reach out to Support.