Carepatron managed billing handles insurance and patient billing on your behalf so you can focus on clinical work. This article covers how the service is priced, what is included, what is not, and what happens when you sign up or cancel.
Who this article is for: Practice owners and administrators currently using or evaluating Carepatron's managed billing service. The service is currently available in the United States only.
Pricing structure
Fee structure
Two fees apply and are charged together. Neither replaces the other.
Base fee: Charged per Billing Clinician per month, regardless of claim volume
Collections fee: 3.9% of all amounts collected, charged on top of the base fee
Platform subscription: Billed separately. Managed billing does not include the Carepatron platform plan.
Total cost formula: Platform plan + base fee (monthly or annual rate) + 3.9% of collections.
Plan options
Two base fee rates are available. Choose based on your provider headcount stability and preferred billing cycle.
Monthly at $99 per Billing Clinician/month | Annual at $79 per Billing Clinician/month, prepaid |
Cancel with 30 days written notice. No upfront commitment. | $948 per seat per year, paid upfront. If a clinician leaves, the seat can be filled by a replacement at no additional charge for the remainder of the term. |
Choose monthly if your provider headcount changes frequently or you prefer to avoid upfront payment. | Choose annual if your provider headcount is stable and you want the lower per-seat rate. |
When billing starts
The base fee starts on the Service Commencement Date: the earlier of onboarding completion or 30 days after contract signature.
Credentialing timeline: Payer credentialing takes 60 to 180 days and is controlled by the payer. The base fee applies during this period. Insurance billing is not available until credentialing is approved.
Providers added mid-month are prorated for the partial month, then billed in full from the next billing cycle.
Free credentialing
What credentialing covers
Credentialing is included in the base fee. The following are covered per provider:
Initial enrollment with up to 5 payers
CAQH ProView setup and ongoing management
Re-attestation and re-credentialing for existing payers
Medicare, Medicaid, and all commercial payers
Additional payers beyond 5: $49 per provider per payer, one-time fee.
Carepatron cannot guarantee payer approval or a specific credentialing timeline. Applications are submitted within 10 business days of receiving your documentation. Payer approval timelines are outside Carepatron's control.
Credential ownership
All credentialing is performed under the provider's own NPI and Tax ID. Carepatron acts as agent only. Credentials are not transferred to or owned by Carepatron at any point.
Transferring from another billing company: Credentials are portable. If a previous company managed your CAQH profile, Carepatron can take it over. Payer records may need to be updated to redirect ERA and EFT payments to the new setup.
Service scope
What's included in the service?
Claim preparation and submission. Insurance and patient billing
Benefits verification and eligibility checks
Denial management. Root cause identification, appeal preparation, and resubmission
Payment posting and reconciliation
Patient billing and statement generation
AR follow-up and aging management
Monthly financial reporting. Account analysis, aging report, and AR reconciliation. Delivered within 10 business days of month-end.
Real-time claim tracking. Claim status visible in the platform: submitted, processing, approved, denied
What's not included in the service?
Prior authorizations. Obtaining, submitting, and monitoring prior auths is the provider's responsibility
Clinical coding. CPT and ICD code selection is the provider's responsibility. Carepatron submits the codes provided.
Workers' compensation and auto personal injury billing. Not covered under the standard agreement
Pre-existing aged AR (accounts over 90 days before enrolment). The service covers dates of service from the commencement date forward only
Payer rate renegotiation. Credentialing and rate negotiation are separate services. Rate renegotiation is not included.
Data and credential portability on cancellation
On cancellation, Carepatron provides:
A full accounting of all open claims at the time of termination
All billing data exported in a standard format (CSV or PDF)
Credentials remain under the provider's own NPI and are unaffected by cancellation
FAQs
Is there a monthly minimum charge?
No separate minimum applies. The base fee covers all claim volumes for that month. However, this is fee is separate from your platform subscription (Plus or Advanced).
How do I track claim status?
Claim status is visible in real time inside the Carepatron platform. Monthly reports are delivered within 10 business days of month-end.
We bill under an organizational NPI. How does that work?
Carepatron credentials and bills under your NPI and Tax ID, whether individual or organizational. Contact the billing team before enrolment to confirm the correct configuration for your practice structure.
What happens if a clinician leaves mid-term on the annual plan?
The vacated seat can be filled by a replacement clinician at no additional charge for the remainder of the annual term.
Does credentialing include payer rate renegotiation?
No. Credentialing covers enrollment only. Rate renegotiation is a separate service and is not included in the standard agreement.
What happens to outstanding claims if I cancel?
Carepatron continues processing claims submitted before termination for a 90-day runout period. After that, they're entitled to the 3.9% collections fee on any amounts collected for up to 6 months post-runout on claims they filed. You maintain read-only access for them during this period.
Our team will be available to answer any further questions you may have. Just reply via messenger through the Help channel in your workspace.