Skip to content Credex Healthcare streamlines primary care billing by handling crucial administrative tasks for family medicine physicians, NPs/PAs, and primary care network providers. Our specialists handle everything from verifying patient eligibility and submitting CPT codes to managing insurance follow-ups. This enables your staff to focus on patient care, not paperwork or payment monitoring.
Our team provides fast billing turnaround and low claim denial rates, whether you are a solo practitioner, a multi-provider primary care clinic, or a hospital-based internal medicine center.
First-pass claim approval rate
Average primary care billing turnaround time
Credex Healthcare’s affiliated payer networks
Prior authorization & enrollment support
Credex Healthcare provides workflows for billing primary care insurance that checks each claim against the rules set by each payer before sending it in. Our billing experts make sure that the CPT codes are correct, active authorizations are given, supporting documentation is sufficient, and that clean claims are sent. This cuts down on the delays that cost primary care practices revenue monthly, and changes to payer rules are constantly tracked, so your billing stays in line as payer requirements change.
Our primary care billing experts verify that the CPT codes are correct, make sure that current authorizations are correct, review supporting documents, and send in clean bills. This reduces turnaround times that cost primary care clinics money every month. Payer rule changes are always being tracked, so your billing stays in line with what carriers need as they change.
Our primary care billing services in the USA cover the following:
We prepare and submit claims with the proper CPT codes, modifiers, and supporting documentation to guarantee first-pass acceptance. Status of claim is monitored in real time by our team, and follow-ups are performed prior to denial deadlines.
We manage prior authorizations for primary care services, starting them and renewing them before they expire through a centralized log, so no session is ever billed past the deadline.
Our denial management team determines the root cause of each rejected claim and corrects documentation errors and resubmits appeals as needed. We monitor denial trends to prevent them from happening again across your entire billing portfolio.
Our certified coders audit encounter notes for appropriate use of CPT codes for E/M and preventive screenings with applicable modifiers to protect you from payer audits and take-backs.
We credential and enroll in your private insurers and supervise physicians with commercial payers, Medicaid managed care organizations, and employee benefit plans, shortening the time it takes to be eligible for billing.
Credex Healthcare is a dedicated primary care billing service company in the USA. They include the most current information on state insurance coverage laws for primary care, commercial payer credentialing processes, and Medicare reimbursement criteria for primary care treatment and preventive screening.
We process primary care insurance billing for all major commercial carriers, including Aetna, Cigna, UnitedHealthcare, Anthem, and Humana, as well as Medicare for approved diagnoses and state Medicaid programs.
Our claims management process helps reduce average days in accounts receivable, accelerate reimbursements and maintain denial rates below the industry average with proactive eligibility checks and real-time claim tracking.
We manage the supervision and scope-of-practice billing rules for internal medicine and family medicine physicians, including telehealth modifier rules and documentation standards for each payer.
We manage provider credentialing, group NPI billing, and site-specific payer enrollments for multi-clinic or multi-state primary care group practices with a single managed workflow.
Every primary care claim requires the correct CPT codes, encounter documentation, and payer-specific authorization before submission. Credex Healthcare ensures all external requirements are met before endorsement.
We confirm that every primary care provider holds a valid state MD/DO license and board certification, carries an active NPI, and has the correct taxonomy code applied to each claim to prevent immediate denial.
We audit the use of primary care CPT codes 99202-99205 (new patient visits), 99211-99215 (established patient visits), 99385 (new patient preventive visit for 18-39 y/o), and 99395 (established preventive visit for 18-39 y/o), verifying age range, modifiers, and matching encounter notes for every item.
We obtain, track, and renew prior authorizations for primary care services from all active payers. We also keep a central authorization log to ensure no session is billed outside an approved treatment period.
We review ICD-10 diagnosis codes and ensure that each patient's treatment plan meets the medical-necessity criteria required by each payer, including Medicare's preventive screening guidelines.
Every carrier applies its own primary care billing policies. We keep payer guides up to date for every insurer on your panel and apply the applicable protocols to each claim at submission.
A/R Follow-Up
We work on aged A/R reports every week, reprocess unpaid claims before they reach the deadline for timely filing, and take disputes to peer-to-peer review or formal appeal when clinical documentation supports the original claim.
To protect and grow their business income, primary care practitioners need solid financial help. Credex Healthcare is a full-service primary care billing company in the USA. They handle all aspects of the primary care insurance billing process, making sure that everything is covered. Our billing services make sure that payers accept your applications quickly, without any needless delays or rejections.
We take care of all aspects of primary care insurance claims, from entering charges and codes to sending them electronically to all major commercial payers and government programs.
Our primary care billing experts always use the correct modifiers with CPT numbers for standard and preventive office visits. This cuts down on rejections caused by poor paperwork and coding.
Prior Authorization Management
We start, keep track of, and update prior authorizations for primary care services so that your qualified practitioners can continue seeing patients without stopping billing.
When primary care claims are denied, our rejection management team finds the reasons why, prepares clinical arguments, and resubmits the claims, recovering revenue that would have been lost.
We credential your primary care MDs/DOs, keep an eye on providers within insurance networks, and handle ongoing recredentialing, so billing never stops because of gaps in provider application management.
Real-time screens let practice owners see how long it takes to bill primary care providers, how much of their accounts are past due, and how often they are being denied.
Years of Primary Care Billing Expertise
Primary Care Provider Credentialing Success
Claim Compliance Rate Across All Payers
Support Available for All Your Needs
Customized Primary Care Billing Solutions
MD
Erin
“Before Credex, we were losing about 20% of our revenue to denials and late submissions. That amount is almost gone after three months. Their staff is the most knowledgeable about primary care billing numbers that we’ve worked with.”
Practice Manager
Kris
“Many billing companies often treat primary care like other private treatments. The Credex team recognizes the difference between 99385 and 99395 when each variable is used. Our first-pass acceptance rate went up in the first month. When you’re running a multi-provider practice, that level of accuracy is very important.”
DO
Ike
“During the hiring call, Credex won me over by investigating our current workflows. First, the holes in their credentials were patched, and then the old claims that had been turned down were too. Our A/R is better than it was six months ago.”
Clinic Owner
Bastide
“It’s difficult to operate a cash-and-insurance primary care business. Credex handles the insurance side without any issues. Authorizations are on time, claims are sent correctly, and any rejections are handled the same week. I’m generating more revenue monthly, and my admin costs plummet.”
Operations Director
Joel
“We have 10 providers across 3 partner clinics. This situation was a problem before Credex was monitoring all their credentials and statements. They filled in the registration gaps and listed all the payers. But there is only one process that makes everything work.”
Practice Assessment
We audit your current billing workflow, AR aging, denial history, and payer mix. This provides an overview of your revenue’s pain points and aspects to monitor.
Credentialing & Payer Enrollment
We confirm that every primary care provider in your practice is credentialed with all applicable payers. We fill any enrollment gaps prior to billing.
Authorization Management Setup
We review your active authorizations and match them to your patient schedule to establish a proactive renewal calendar so that we never bill a session without payer approval.
Claim Processing
Our primary care billing experts review the encounter documentation, use proper CPT codes and modifiers, and submit claims electronically to all commercial payers and government insurers.
Denial Management & Follow-Up
We track each claim through the adjudication cycle. Denials are processed with the appropriate responses, the root cause is determined, an appeal is prepared, and resubmission is executed within 48 hours.
Reporting & Ongoing Optimization
You get regular updates on acupuncturist collection rates, rejection trends, balances of past-due accounts, and billing cycles.
What differentiates Credex Healthcare from other primary care billing companies in the USA is our depth of specialization in general medicine and primary care billing, as well as our accountability to the practices we serve. Our billers and coders apply hands-on knowledge of requirements for primary care insurance billing, current CPT coding rules, and payer-specific authorization workflows to protect your revenue and keep your practice compliant.
If you work with a primary care billing expert, that person knows your needs and preferences for revenue optimization.
Our team is trained specifically in the primary care billing process. The coding rules, authorization workflows, and documentation standards for primary care are distinct, and we know them in detail.
You always know where your money is. Our reporting dashboard gives practice owners live visibility into claim status, denial rates, A/R aging, and collection performance with no black boxes.
Our payment process adheres to HIPAA requirements. Strict security measures and full compliance documents are used to handle patient data.
At Credex Healthcare, we know how to get your primary care reimbursement processed quickly, without delays or denials. Let us enhance your primary care practice revenue and growth with our extensive experience and expertise in medical primary care billing.
Our skilled team provides effective revenue optimization, focused outcomes, and excellent client service. Our regular medical billing operations are managed by a team of experts with the capabilities customers expect from a professional billing company.
You will receive full reimbursement for your primary care services through our clean claim submission, identifying and resolving stuck payments, and promptly addressing and handling denied claims.
Primary care treatment billing services handle all a practice’s income, from filing and submitting claims to handling denials and following up with insurance companies. Without specialized primary care billing assistance, practices risk being frequently denied claims, not being reimbursed on time, and failing to follow the rules. A specialized primary care billing business like Credex Healthcare makes sure that your bills are sent correctly the first time.
Yes. Insurance covers primary care, but the amount of coverage varies a lot depending on the provider, the state, and the specific plan. Most of the time, treatment must be deemed medically necessary for conditions like chronic pain. Credex Healthcare offers specialized primary care billing services that help with these complex aspects.
When billing for primary care, the most used CPT codes are 99202–99205, 99211–99215, 99385, and 99395. HCPCS codes are also applied to applicable preventive services and screenings.
E-claims for primary care billing usually take 30 to 45 days to receive reimbursement, but without help from a billing expert, they can take 60 to 90 days. The timeline depends largely on submitting clean claims to the insurance company. Submissions are usually processed much faster than traditional claims.
The billing industry is rapidly evolving. By the year 2025, the system and tools used
Billing companies ensure compliance with HIPAA and other regulations by being legitimate and reliable. Every
At Credex Healthcare, we know how frustrating it is when claims are denied. That is
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