This case study demonstrates how experienced credentialing specialists can recover failed Medicare applications, resolve Out-of-Network payer issues, obtain Single Case Agreements (SCAs), and restore reimbursement opportunities for behavioral health providers. It also highlights the importance of accurate documentation, payer communication, and strategic follow-up throughout the insurance credentialing process.
Credentialing & Enrollment
Recovering a Denied Medicare Waiver & Securing 7 Single Case Agreements
Learn how Edge RCM helped a behavioral health provider recover from a denied Medicare Waiver Program application, secure 7 Single Case Agreements (SCAs), resolve Out-of-Network issues, and rebuild their commercial insurance credentialing after previous submission errors.
Client Overview
1-provider Internal Medicine solo practice
This client asked not to be named. Everything else, including the numbers, the timeline and the work, is exactly as it happened.
Solo practicePractice type
Internal MedicineSpecialty
1Providers
MarylandLocation
Services provided
The engagement
The challenge
A behavioral health provider came to Edge RCM after their Medicare Waiver Program application was denied and commercial insurance payers, including UnitedHealthcare, listed the practice as Out-of-Network. Previous credentialing errors caused reimbursement delays, denied claims, and revenue loss.
What we did
Edge RCM conducted a complete credentialing audit, identified submission errors, introduced a Single Case Agreement (SCA) strategy for existing patients, corrected the Medicare Waiver application, resubmitted all required documentation, and continued commercial payer enrollment until approvals were secured.
The results
The provider received approval for the Medicare Waiver Program, obtained 7 approved Single Case Agreements, secured approvals from most targeted commercial insurance payers, and chose Edge RCM as their long-term credentialing partner.
Before & After
The numbers that changed
Measured on this practice's own data, over the engagement described above.
Medicare Waiver
+100%
Before
0
After
1
Approved SCAs
+7
Before
0
After
7
Approved Commercial Payers
266.7%
Before
3
After
11
Key takeaways
• Never assume a denied Medicare application cannot be recovered.
• Single Case Agreements can help generate revenue while providers remain Out-of-Network.
• Accurate documentation and payer-specific expertise significantly improve credentialing success.
• A proper credentialing strategy protects both reimbursement and long-term practice growth.
Related Services
The services behind this result
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