# The Credentialing Gap > Credentialing delays hold back cash flow for new providers. See where the gap opens and how WeBill Health closes it with managed enrollment. Source: https://webillhealth.com/credentialing-gap/ Publisher: WeBill Health Last updated: November 2, 2026 Credentialing Every day between a provider’s first patient and the day their Medicare application is filed is either recoverable or destroyed. This works out which, using your numbers and the federal rule. Medicare sets your effective date as the **later** of the day you filed and the day the provider started. Retrospective billing then reaches back **30 days from that effective date**, not from the start date. Anything earlier is unbillable, permanently. Source: CMS Program Integrity Manual, chapter 10, section 10.6.2. ### Where the days go Enter both dates to see where the days fall. Destroyed, outside the 30 days The 30 day boundary Recoverable once approved $0 Medicare revenue destroyed, not deferred 0 Days outside the retrospective window 0 Days recoverable once approval lands ### What this deliberately does not calculate Your Texas Medicaid share covers 0 days of exposure and this leaves it unpriced. The 365 day retroactive enrollment that gets quoted is gap closure for providers who failed to revalidate between November 2023 and December 2024. It does not reach a new provider. A separate 2022 HHSC policy did permit retrospective billing dates for new enrollments, but the table defining the window is published as an image that no longer renders, and the TMHP manual still states the effective date aligns with approval. Managed care is a second gate. MCO participation does not inherit the fee for service effective date. Each plan sets its own, and TMHP states it has no visibility into them. Your commercial share, 0 days, depends on the retroactive language in each contract. What happens next ### We tell you which days are still recoverable, and we file to protect the next hire. Send the start dates and filing dates for every provider you onboarded in the last twelve months. We come back with the days still inside the window, the days that are gone, and the dollar figure attached to each. Then we hold the clock on the next one. The findings are yours either way. [Get My Free Revenue Audit](/revenue-defense-audit/request/) The 30 day retrospective billing window and the effective date rule come from the CMS Program Integrity Manual, chapter 10, section 10.6.2, and from 42 CFR 424.520(d). A presidentially declared disaster extends the window; this calculator uses the standard 30 days. Encounter volume, collected value per encounter and payer mix are your figures and are not stored or transmitted. The figures above describe the effect of a federal billing rule on the dates you entered. They are not a WeBill Health performance claim and they are not legal or billing advice. ## Put your real dates in front of us Questions ## Medicare credentialing gap questions What is the Medicare effective date for a new provider? Medicare sets the effective date as the later of the day the enrollment application was filed and the day the provider started at your location (CMS Program Integrity Manual, chapter 10, section 10.6.2). How far back can a new provider bill Medicare? Retrospective billing reaches back 30 days from the effective date, not from the start date, under 42 CFR 424.520(d). Services before that window cannot be billed. A presidentially declared disaster can extend the window. Does Medicaid managed care follow the same effective date? No. Managed care participation does not inherit the fee for service effective date. Each plan sets its own, so every plan has to be tracked separately. How does WeBill Health close this gap? Revenue Velocity Credentialing files early and monitors CAQH and PECOS 24/7, reducing enrollment lag by up to 40% so the next provider starts inside the billable window. QFReviewed by [Qasim Faizan](/qasim-faizan/), Chief Operating Officer, WeBill HealthLast updated September 28, 2026 WeBill Health is a specialty focused revenue cycle management partner for independent practices. Request a Revenue Defense Audit at https://webillhealth.com/form/