Case Study:
Scaling Credentialing for a Nationwide Women’s Health Clinic
“A fast-growing women’s health clinic focused on telehealth services for menopause care set out to expand its operations across all 52 U.S. states. The clinic had a large team of nearly 100 providers, and the goal was to enroll them with Medicaid, Medicare, and commercial payers nationwide—while ensuring compliance, speed, and sustainability.”
The Challenges
This ambitious national rollout came with several complex challenges:
- Ensuring that all providers held valid licenses in every state, particularly for telehealth.
- Monitoring expiration dates and renewal timelines for licenses across multiple jurisdictions.
- Keeping CAQH profiles accurate, especially with varying practice addresses per state.
- Securing group-level contracts with favorable reimbursement rates (rather than enrolling individual providers).
- Making sure the right CPT codes were billable under each payer, for each state
Our Solution
Umulisa Health stepped in to manage and scale the credentialing effort with precision and transparency:
- Conducted a full licensing audit, identified missing or invalid licenses, and implemented a tracking system for renewals and expirations.
- Maintained and updated CAQH profiles for each provider, ensuring consistency in address, license, and credentialing data.
- Negotiated and submitted group contracts with major payers to centralize billing under the clinic rather than individual NPI numbers.
- Verified CPT code coverage per payer to prevent billing issues post-enrollment.
- Migrated the project from a static Google Sheet to a centralized software platform that gave real-time visibility into:
• Credentialing status of each provider
• License renewal and re-credentialing timelines - Future enrollment timelines (3, 6, 9 months out), allowing the client to plan state- by-state rollouts
The Results
Scaled from a $10,000 to a $120,000 engagement over 12 months
Created a fully trackable, automated credentialing dashboard
Positioned the clinic to be operational across the U.S. with full visibility
Secured payer contracts with strong reimbursement terms and group NPI structure
Helped establish the client as one of the fastest-growing companies in women’s telehealth