Provider Pipeline
New Provider Volume — by Tier
Enter counts, daily revenue, and actual enrollment days by provider type. Each tier calculates independently: your 2 surgeons or specialists delayed 110 days likely generate more leakage than your 12 APPs combined.
Provider type
# / year
Daily rev ($)
Actual days
APPs (NP/PA)
~$1,100–1,200/day
$
days
Physicians (non-surgical)
~$1,500–1,900/day
$
days
Surgeons / Specialists
~$3,000–8,000+/day
$
days
Benchmarks reflect professional fee collections, not compensation. Zero out tiers that don't apply to your organization.
Enrollment Delay
Target Credentialing Window
The target applies across all provider tiers. Actual enrollment days are entered per tier above — delay is calculated independently for each.
days
With delegation: 30–60 days achievable.
Without delegation: 90–120 days typical.
UHC/Optum: 120–240 days reported.
Without delegation: 90–120 days typical.
UHC/Optum: 120–240 days reported.
Delegation Failure
Payer Delegation Breakdown
When a delegation agreement lapses or fails audit, providers require full re-credentialing. Suspension (corrective action plan) adds 30–60 days. Full revocation resets the enrollment clock entirely -- 90–180 days.
Full revocation — complete re-credentialing required. No interim billing path. Typical range: 90–180 days.
days
Retro-Load Gap
Retroactive Billing Recovery
Retro billing availability varies dramatically by payer type. Many commercial payers allow zero retroactive billing. Medicare allows 30 days measured from the application filing date, not the approval date. Use the payer mix selector to set a realistic default.
Blended environment — adjust based on your actual Medicare/commercial split. 60 days is a ceiling, not a midpoint, for most commercial-heavy practices.
Model assumptions: All figures represent estimated revenue at risk based on modeled inputs. Actual leakage varies by payer contract terms, specialty, market, and internal credentialing process maturity. The delay percentage is applied uniformly across all provider tiers. In practice, APP delay rates are typically lower than physician rates, particularly with mature delegation. A single target enrollment window applies across all tiers; real-world targets may differ (e.g., 30 days for APPs under delegation vs. 60 days for physicians). Medicare's 30-day retro window is measured from the application filing date, not the approval date, and requires that circumstances precluded advance enrollment. Many commercial payers allow zero retroactive billing -- verify individual contract terms before assuming recovery. Delegation failure days reflect typical re-credentialing cycles; full revocation after a CAP breach may extend to 150–180 days in some markets. Suspension/CAP scenarios assume no interim billing; if your payer contract allows provisional participation during the corrective action period, adjust days downward accordingly. Hard delay loss is characterized as permanently irrecoverable in most payer contracts; limited exceptions exist under Medicare disaster waivers and some state Medicaid programs. Severity thresholds (Elevated: $400K, Critical: $1M) are calibrated for organizations onboarding 10–30 providers per year — adjust expectations for solo practices or large health systems. This tool is designed for operational diagnostics and planning -- not for audit or legal purposes.
Revenue at Risk
Critical Exposure
Estimated Annual Leakage
$0
estimated annual revenue at risk
Hard delay loss (beyond retro reach)
$0
Delegation failure losses
$0
Retro-eligible gap — operationally fixable ↩
$0
Gross delay exposure$0
Less: retro recovered−$0
Net delay at risk$0
Diagnostic
Calculating...