Draft for legal review
Credentialing Service Agreement
This Credentialing Service Agreement (the "Agreement") is between Skyscrapers Now LLC, doing business as Northgate Billing ("Northgate", "we", "us"), 811 S Central Expy, Ste 205, Richardson, TX 75080, and the practice named in the intake form (the "Practice", "you"). It takes effect on the date you sign it electronically below (the "Effective Date").
1. Services
For each provider listed in your intake ("Provider") and each payer you select ("Payer"), Northgate will: (a) verify the Provider's NPI, license and registry records; (b) create or update and attest the Provider's CAQH profile; (c) prepare, complete and submit the enrollment and credentialing application for each Payer, including Medicare through PECOS where selected; (d) follow up with each Payer at least every 14 days until the Payer issues a decision; (e) correct and resubmit any application returned for a fixable reason at no additional charge; (f) review the participation contract and confirm the effective date loaded in the Payer's system; and (g) send a written status update each week from the week of first submission.
2. What is not included
Payer-side application or enrollment fees, state licensing fees, hospital privileging, primary-source verification for employers, re-credentialing and ongoing maintenance (available separately), and any service for a Provider or Payer not listed in your intake.
3. Fees
The fee is a one-time flat fee of $1,200 per Provider, which covers up to eight (8) Payers for that Provider and one practice location, plus $120 for each additional Payer beyond eight for that Provider. Where three (3) or more Providers are enrolled under the same intake, the per-Provider fee is $1,000 (the "Group Rate"). Each practice location beyond the first is $120 per Provider per location, charged only where a Payer requires a separate application per location. The total shown on your intake summary is the full fee for the Services. There is no setup fee, no percentage of collections and no automatic renewal. If a Provider is enrolled with fewer than eight Payers, the unused places remain available for six (6) months from the Effective Date: you may add a Payer for that Provider by email at no additional charge during that period, and we will file it within ten (10) business days of a complete file. A Payer added after that period, or after the Provider's file has closed, is charged at $120 per Payer. Each Payer, including each Medicaid managed care organization and each behavioral health network, counts as one Payer.
Changes after signing. You may add a Provider, Payer or location at any time through your file page or by email. Additions are covered by this Agreement at the rates above, with the same 50/50 payment terms charged to the payment method on file after an emailed confirmation; a Provider added later takes the Group Rate if the file then has three or more Providers. If you remove a Provider, Payer or location before any application has been submitted for it, the amount paid for it is refunded within ten (10) business days; after submission the deposit for that item is retained and no Balance is owed for it. Removing a Payer within the first eight for a Provider does not change the fee.
4. Payment
Fifty percent (50%) of the total fee is due when you sign this Agreement (the "Deposit"). The remaining fifty percent (50%) (the "Balance") is due when the first Payer approves the first Provider, and you authorize Northgate to charge the Balance to the payment method on file at that time. We will email you a receipt before and after each charge. Payments are processed by Stripe; Northgate does not store your card or bank account number. If a Balance payment fails or a bank debit is returned, we will tell you by email and continue work for fourteen (14) days; if the Balance remains unpaid after that period, work on the file pauses until payment is received, and no new application is submitted while a payment is outstanding.
5. Closed panels, denials and credits
If a Payer confirms that its panel is closed to the Provider's specialty or area, we will tell you in writing before filing, submit an appeal where one is available, and if the panel stays closed you will not be charged for that Payer: the Payer is removed from the count for that Provider, and any resulting difference is refunded to the Deposit or deducted from the Balance. If a Payer issues a final denial for a reason outside the control of either party after a complete and accurate application, the fee for that Payer is credited toward another Payer of your choice for the same Provider.
6. Your responsibilities
You will: provide accurate and complete information and documents, including each Provider's Social Security number and date of birth through the secure file page or by phone to your account lead (never by email); sign Payer applications and CAQH authorizations in each Provider's own name where a Payer requires it; respond to our requests within five (5) business days; keep licenses, malpractice coverage and CAQH access current during the engagement; sign applications promptly where a Provider signature is required; and tell us of any change in practice location, ownership, tax identification or Provider status within five (5) business days. Delays caused by missing information, expired documents or Payer processing extend our timelines accordingly.
7. Timelines
We will submit each application within ten (10) business days after we receive a complete file for that Provider and Payer. Payers set their own review times, typically 60 to 120 days, and Northgate does not guarantee approval, an effective date or a decision within a particular period.
8. Term and cancellation
This Agreement begins on the Effective Date and ends when every selected Payer has issued a decision for every Provider or the Agreement is cancelled. You may cancel at any time by email. If you cancel before any application has been submitted, the Deposit is refunded in full within ten (10) business days. If you cancel after any application has been submitted, the Deposit is retained for work performed and no Balance is owed. Northgate may end the Agreement with written notice if you fail to provide required information for sixty (60) days or more, after at least three written reminders and one call; in that case the same refund rule applies. For a practice that does not yet have an EIN or group NPI, individual applications proceed and group enrollment waits for those numbers; if they are not provided within sixty (60) days the group portion is treated as cancelled under this Section.
9. Confidentiality and HIPAA
Each party will keep the other's non-public information confidential. Where Northgate receives protected health information, the Business Associate Agreement signed alongside this Agreement governs. Northgate stores your documents in encrypted form and limits access to the staff assigned to your file.
10. Authorization
You authorize Northgate to act on your behalf with CAQH, Medicare, Medicaid and the selected commercial Payers for the purpose of the Services, including creating accounts, submitting applications and corresponding about them. We will not sign a participation contract on your behalf; contracts are presented to you for signature.
11. Limitation of liability
Northgate's total liability under this Agreement is limited to the fees you have paid under it. Neither party is liable for indirect, consequential or lost-revenue damages, including revenue not collected while a Provider is out of network, except for breaches of Section 9 or amounts that cannot be limited by law.
12. General
This Agreement, the intake summary and the Business Associate Agreement are the entire agreement between the parties and replace any earlier discussion or quote. It is governed by the laws of the State of Texas. Changes must be in writing and signed by both parties; email with an express agreement counts. Electronic signatures are binding. If any clause is unenforceable the rest remains in effect.
Signed electronically by the Practice's authorized representative below. A signed copy is emailed to you and retained by Northgate with the date, time and IP address of signature.
