Credentialing Pipeline
Skyline Home Health Care — Payer enrollment, CAQH status, contracted rates, and target payer outreach — CRED agent
HIPAA NOTICE: This dashboard contains no protected health information (PHI). Zero patient identifiers. Insurance/payer business data only.
Active Contracts
3
Medicare, Humana, Aetna
CONTRACTED
In Process
3
Pinnacle, RMHS, BCBS
PENDING
Target Payers
5
TriWest, Anthem, CIGNA, Kaiser, Aetna BH
OUTREACH 60-90d
CAQH Profile
Active
Quarterly attestation
CURRENT
NPI (Agency)
1104334887
Skyline Home Health Care
VERIFIED
DMEPOS Enrollment
Pending
Surety bond + NSC needed
IN QUEUE
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Phase 2 Integration: When Skyline OS launches, this dashboard will auto-pull live credentialing data directly from CAQH, CMS, and the payer enrollment portal. All payer status, contract dates, and follow-up dates will update in real-time. The layout and design shown here stay exactly the same — only the data becomes live.
Current Contracted Payers
Medicare (CMS)
Federal — Home Health PPS / PDGM
ACTIVE
Billing ModelPDGM — 30-day periods
LUPA ThresholdMin 2 visits/period
NOA Deadline5 days from SOC
Primary Volume~70% of census
Underpayment RiskCRED monitors contracted rate
Humana
Medicare Advantage / Commercial
CONTRACTED
Auth RequiredYes — per episode
Auth TrackingHAVEN monitors expiration
Rate StatusUnder review — CRED
Contract RenewalPhase 2 will auto-alert 90d prior
Aetna
Medicare Advantage / Commercial
CONTRACTED
Auth RequiredYes
Aetna BHSeparate credentialing — target
Rate StatusContracted
Pinnacle
Medicare Advantage
IN PROCESS
Application StatusSubmitted — awaiting review
CRED Follow-up60-90 day outreach cadence
Next ContactPhase 2 will auto-track
Rocky Mountain Health Solutions (RMHS)
Medicaid — Colorado
IN PROCESS
Payer TypeCO Medicaid Managed Care
StatusApplication in review
CRED OwnerCRED — 60d follow-up schedule
Blue Cross Blue Shield (BCBS)
Commercial + Medicare Advantage
IN PROCESS
StatusCredentialing in progress
CAQHVerified
Est. Timeline45–60 days
60–90 Day Target Payer Outreach
PayerTypePriorityOutreach StatusNext StepPotential Value
TriWest Healthcare VA / Veterans P1 HIGH OUTREACH PENDING Initial contact letter — CRED drafts HIGH — CO veteran population
Anthem BCBS Colorado Commercial + Medicare Advantage P1 HIGH OUTREACH PENDING CAQH app + provider enrollment HIGH — large commercial network
CIGNA Commercial P2 OUTREACH PENDING CAQH + provider portal registration MEDIUM
Kaiser Permanente Commercial / Group P2 OUTREACH PENDING Kaiser provider enrollment portal MEDIUM — strong CO presence
Aetna Behavioral Health Behavioral Health wing of Aetna P3 NOT STARTED Separate credentialing from Aetna main LOW — expand after main contracted
Open Credentialing Actions — CRED
CRED
Send TriWest outreach letter
Draft provider enrollment inquiry to TriWest VA network. Samuel signs as Director of Operations.
CRED
Follow up Anthem BCBS Colorado application
Provider enrollment portal + CAQH. 60-90 day follow-up cadence required.
CRED
CAQH attestation — quarterly update
Ensure CAQH profile is current. All payers verify against CAQH. Out-of-date = enrollment freeze.
SAMUEL
DMEPOS enrollment — initiate
DME supplier surety bond + NSC enrollment. COMPLY + CRED coordinate. Medical supply revenue opportunity.
CRED
Monitor contracted rates — underpayment detection
Compare EOBs against contracted rates. Flag if paid < contracted amount. Not a denial — a rate violation.
Credentialing by the Numbers
Average credentialing timeline
60–120 days
CAQH re-attestation
Every 90 days
Follow-up cadence (target payers)
Every 30 days
Contract renewals monitored
90-day pre-alert
PHASE 2 — Live Data Integration
All credentialing dates, follow-up schedules, and contract expiration alerts will auto-populate from the Skyline OS database. This UI stays the same — only the data source changes.
Skyline Home Health Care  |  NPI: 1104334887  |  Director of Operations: Samuel Mfinanga  |  samuel@skylinehomecare.org CRED Agent  |