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The valley is the cash-flow gap between your last employer paycheck and your first full payer payment. For most physicians leaving employment, this gap runs 90–180 days. It's real, plannable, and financeable — once you know your number. The valley calculator gives you a personalized estimate based on your specialty, payer mix, and go-date.

Typically 90–165 days per payer when applications go in clean and on time. Most practices run months longer because CAQH ProView is started late, payers are applied to one at a time instead of simultaneously, and follow-up falls through the cracks. Elf preps CAQH in the first week and builds every target payer application so they file in parallel — by you, or by our team on team plans.

Elf coordinates both. Medicare enrollment is submitted through PECOS — we walk you through each attestation and track every open item so nothing slips. Medicaid varies by state; Elf knows the specific sequence and deadlines for each state's program. Both are part of the standard engagement.

All outpatient specialties: primary care, internal medicine, family medicine, psychiatry, psychology, OB/GYN, dermatology, orthopedics, neurology, gastroenterology, and more. Behavioral health has additional credentialing requirements — CAQH behavioral health attestations, CAQH supplemental applications — and Elf preps and tracks those too.

Elf reviews your profile and builds your personalized board — the 51 steps from contract review through first claims submission. CAQH ProView is the first sprint: Elf preps it step by step so your payer applications can file in parallel rather than one at a time. Every open item, its current status, and who holds it lives on your board.

Some steps require your signature or direct attestation — CAQH attestations, hospital credentialing applications, certain state license renewals. Elf tells you exactly what, when, and how — with 48-hour advance notices so nothing lands as a surprise.

A credentialing service submits paperwork. Elf coordinates the entire Exit → Launch → Fill → Sustain arc: contract review, entity setup, CAQH, payer applications, denial follow-up, and live cash-flow modeling. You see every open task in real time — not a quarterly status call.

Elf tracks every application status and catches denials before they stall your timeline. Most denials are addressable — Elf knows the common denial reasons by payer, surfaces the right response, and drafts the follow-up; on team plans our team works it. Nothing sits in a queue without an owner.

Flat monthly fee. No percentage of revenue, no referral fees, no hidden billing. Self-directed and Done-with-you are month-to-month subscriptions; Done-for-you is scoped as a custom engagement. See the pricing page for current tiers.

No. Every tier is month-to-month — cancel any time, no penalty. PracticeElf is built to carry you through the launch window and stay on for ongoing credentialing, re-credentialing, and renewal tracking.

Self-directed and Done-with-you start when you subscribe — no discovery call required, cancel any time. Done-for-you starts with a scoping call and a signed engagement plan before any payment is due.

All data is encrypted in transit and at rest. Elf only stores the information needed to coordinate your credentialing. We do not sell data, and we never share your NPI, tax ID, or payer credentials with third parties outside of the direct enrollment process.

SaaS subscription at a flat monthly fee — never a percentage of the physician's collections. Three tiers from self-directed ($299/mo) to done-with-you ($799/mo) to custom white-glove. The same AI infrastructure (Elf) serves all three tiers; marginal cost to serve additional customers scales far below revenue per customer as volume grows.

Physicians, nurse practitioners, PAs, and therapists leaving employed settings to start independent practices. MGMA survey data puts the annual flow at roughly 21,000 physicians — about 6% of the 350,000 employed — with NPs, PAs, and therapists adding more each year. The shift from hospital-employed to independent has accelerated since 2021 — driven by private equity consolidation, administrative burden, and autonomy pressure.

PracticeElf is built by Physician Practice Specialists (PPS), which has credentialed hundreds of independent providers across outpatient specialties. The 51-step launch checklist, payer timeline benchmarks, and valley estimates inside Elf are grounded in real casework — not generic templates. The AI layer and dashboard are built in-house.

We're in active conversations with healthcare-aligned investors and strategic partners. Reach out at [email protected] or via the /demo page to start a discussion.