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Payor enrollment

Approving payor enrollment drafts

3 min read

CredTek's enrollment agents fill the Optum, Carelon, Magellan, Evernorth, and Anthem BH applications end-to-end — but nothing leaves CredTek without your click. The human-in-the-loop gate is on the architecture (per the IAL spec), not a feature flag.

The approval queue

Open /approvals. You see every drafted submission, license renewal, CAQH attestation, and PSV anomaly that needs your eyes — sorted by urgency.

Approve, edit, or reject

  • Approve & send — the most common action. The agent submits to the payor portal, transitions the IntegrationJob to submitted, and logs to the audit chain.
  • Edit — opens an inline editor. Most coordinators never need this; agent drafts have a 97% accept-as-is rate. But if the payor has a quirk we missed (a specific phrasing they require in a free-text field), this is where you fix it.
  • Reject — dismisses the draft and asks the agent for a new one (or stops the workflow, depending on action type).

How the agent draft is built

From the provider's golden profile (intake + PSV results + CAQH sync). The agent fills every field on the payor's portal, attaches the right documents, and stages the submission. You see exactly what will be sent.

Stalled submissions

When a Tier 3 submission stays in submitted status past 45 days, the SLA monitor auto-creates a Tier 4 escalation ticket — internal ops calls the payor's provider relations team to unblock. Visible to you on the customer-facing job; the ops surface lives at /ops/queue.

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