Credentialing & Enrollment

Provider Credentialing & Payer Enrollment Services

Get your providers credentialed and enrolled with the right payer networks faster. Our credentialing specialists manage every application, expirable, and re-credentialing cycle so your providers can focus on patient care while revenue flows from day one.

45-Day Avg Enrollment Time
100% Expirable Tracking
500+ Payer Networks

Full-Service Credentialing Solutions

From initial application assembly to ongoing re-credentialing, we manage the entire provider enrollment lifecycle across every payer, state, and facility your organization requires.

New Provider Enrollment

Complete end-to-end enrollment for new providers, including application preparation, primary source verification, CAQH profile setup, and submission to all required commercial, Medicare, and Medicaid payer networks. We manage the entire process to get your providers billing-ready in as few as 45 days.

Re-Credentialing

Proactive re-credentialing management that begins 120 days before each deadline. We update all application data, verify current licenses and certifications, submit renewal applications, and follow up with every payer to ensure continuous network participation with zero gaps in coverage.

CAQH Management

Full CAQH ProView profile creation and ongoing maintenance. We build complete, accurate profiles, upload supporting documents, respond to payer data requests, re-attest quarterly, and ensure your providers' CAQH profiles are always current and accessible to credentialing organizations.

License & Expirable Tracking

Automated tracking of every license, certification, DEA registration, malpractice policy, board certification, and continuing education requirement for every provider in your organization. We send 90-, 60-, and 30-day renewal alerts and manage the renewal process to prevent any lapse.

Payer Contract Negotiation

Strategic support for payer contract negotiations, including fee schedule analysis, market rate benchmarking, and term optimization. We help you understand your current reimbursement position, identify underperforming contracts, and negotiate better rates that align with the value your providers deliver.

Delegated Credentialing

For large groups, health systems, and MSOs, we manage delegated credentialing programs that meet NCQA standards. Our team handles the credentialing committee process, maintains compliant files, conducts internal audits, and manages payer delegation agreement requirements.

How We Get Your Providers Enrolled

A streamlined, transparent process that takes the complexity out of credentialing and gets your providers earning revenue faster.

Data Collection & Verification

We gather all required provider information, conduct primary source verification of education, training, licensure, board certification, and work history, and build a comprehensive credentialing file that satisfies the requirements of every target payer.

Application Preparation

Our specialists prepare CAQH profiles, complete payer-specific applications, compile supporting documents, and quality-check every submission for completeness and accuracy before it leaves our office. Incomplete applications are the top cause of enrollment delays, and we eliminate them.

Submission & Follow-Up

Applications are submitted to each payer and tracked in our credentialing management system. We follow up at defined intervals, respond to payer requests for additional information within 24 hours, and escalate stalled applications through payer provider relations contacts.

Approval & Ongoing Maintenance

Upon approval, we confirm effective dates, update your billing systems with provider numbers, and transition the provider to our ongoing monitoring program. Expirables, re-credentialing deadlines, and CAQH re-attestation dates are tracked automatically going forward.

Credentialing Delays Cost You Real Revenue

Every day a provider is not enrolled with a payer is a day you cannot bill for their services. For a busy provider seeing 20-30 patients per day, enrollment delays of even 30 days can mean $50,000-$150,000 in lost or delayed revenue. Worse, retroactive billing limitations at many payers mean some of that revenue is lost permanently.

  • Average enrollment reduced from 90-120 days to just 45 days
  • Zero enrollment lapses from missed re-credentialing deadlines
  • 100% expirable compliance across all providers
  • Backdated effective dates secured wherever payer policy allows
  • Complete CAQH, PECOS, and state Medicaid enrollment management
Enroll Your Providers Now
45
Day Average Enrollment
$150K
potential revenue lost per month of delay
45 Days
Average Payer Enrollment
100%
Expirable Compliance Rate
500+
Payer Networks Supported
0
Enrollment Lapses Last 12 Months

Frequently Asked Questions

Common questions about our provider credentialing and payer enrollment services.

Our average enrollment time is 45 days from application submission to effective date. This compares favorably to the industry average of 90-120 days. The timeline varies by payer; Medicare and Medicaid typically process within 30-45 days, while some commercial payers may take 60-90 days. We accelerate the process by submitting complete, error-free applications and following up aggressively with every payer at defined intervals.
Yes. We manage complete Medicare enrollment through PECOS, including individual provider enrollment, group reassignment, practice location updates, and specialty changes. For Medicaid, we handle state-specific enrollment applications, manage the often complex state Medicaid portal requirements, and coordinate with managed Medicaid plans. We also manage Medicare revalidation cycles and respond to revalidation requests to prevent involuntary termination.
We provide a comprehensive intake checklist that covers personal demographics, education and training history, licensure details, DEA registration, malpractice insurance certificate, board certification, work history for the past 10 years, hospital privileges, professional references, and any disciplinary or malpractice claim history. Our intake coordinator guides providers through the process and can typically gather all required information within 5-7 business days.
Every expirable document and re-credentialing deadline is loaded into our tracking system with automated alerts at 120, 90, 60, and 30 days before expiration. Our team proactively contacts providers to collect updated documents, submits renewal applications, and confirms completion with the relevant payer or licensing board. We maintain a 100% on-time re-credentialing rate with zero lapses in the past 12 months across all clients.
Absolutely. We routinely manage credentialing for providers practicing across multiple states and locations. This includes coordinating state license applications, managing separate payer enrollments for each practice location, ensuring group NPI and taxonomy codes are correctly configured, and handling the complexity of multi-state Medicaid enrollment. Our centralized tracking system gives you visibility into every provider's enrollment status across all locations and payers.
Yes. Our contract negotiation support includes a full analysis of your current fee schedules compared to Medicare rates and regional benchmarks, identification of underperforming contracts, and development of a negotiation strategy with supporting data. We prepare rate increase requests, draft counter-proposals, and provide the market intelligence and utilization data that payers need to justify improved terms. Many clients see 8-15% rate improvements on renegotiated contracts.