Services
Credentialing and Provider Enrollment Services
A provider who is not enrolled with a payer cannot be paid by that payer, however clean the claim. We prepare and track enrollment and credentialing applications, keep CAQH ProView profiles current and watch revalidation dates, so new providers start billing sooner and existing ones stay in network.
- Medicare enrollment and reassignment through PECOS
- CAQH ProView profiles maintained and re-attested on schedule
- Effective dates confirmed before claims are released
7+ yearsIn medical billing and revenue cycle management
Dedicated account managerYour main contact for billing questions
Multi-specialty teamBilling and coding across many specialties
Free billing auditNo patient data needed to get started
Enrollment and credentialing tasks covered
Medicare enrollment
Initial enrollment, reassignment of benefits to your group, and changes such as new practice locations, submitted through PECOS.
Medicaid and Medicaid MCOs
State Medicaid enrollment followed by credentialing with each managed care plan you want to join, since MCOs credential separately.
Commercial payer applications
Credentialing applications and participation requests for commercial and Medicare Advantage plans, tracked until a contract and effective date are issued.
CAQH ProView maintenance
Profiles completed, documents such as licenses and malpractice certificates kept current, and re-attestation completed on CAQH's current schedule.
NPI and taxonomy alignment
NPPES records checked so the individual and group NPIs, taxonomy codes and addresses match what each payer has on file.
Revalidation and re-credentialing
Medicare revalidation, generally every five years for physicians and other practitioners, and commercial re-credentialing cycles, tracked with reminders well before each deadline.
Official sources: CAQH ProView provider quick reference guide (external site), eCFR: 42 CFR 424.515 (revalidation) (external site)
How an enrollment project runs
Step 1: Collect provider data once
Licenses, DEA, board certification, work history, malpractice and NPI details are gathered in one secure checklist.
Step 2: Build the payer list
Together we decide which payers each provider needs, in priority order based on your patient mix.
Step 3: Submit and chase
Applications are submitted and followed up on a schedule, with every call and reference number logged.
Step 4: Confirm the effective date
Before claims go out, we confirm the provider is loaded in the payer's system with the right effective date and location.
Step 5: Track renewals
Expiring licenses, CAQH attestations and revalidation dates sit on a shared calendar with advance reminders.
Step 6: Report status
You see where every application stands, so scheduling decisions are made with current information. Status updates are shared weekly by email, with a full list in your monthly report.
Typical credentialing situations
A new provider is joining
Each payer has to approve the provider before their visits can be billed under their own NPI.
You are opening a practice or location
New groups and new service locations need group enrollment and address updates with every payer.
A tax ID or ownership change
Changes of ownership or TIN usually require new or updated enrollments, and missed updates lead to payment holds.
A revalidation notice arrived
Medicare and Medicaid revalidation requests have firm deadlines, and missing them can interrupt payment.
Why enrollment delays cost more than they look
The real cost of a slow application is the visits that cannot be billed while it is pending. Medicare allows limited retroactive billing for physicians and practitioners, generally up to 30 days before their enrollment effective date when circumstances prevented enrolling before providing services. Many commercial payers allow no retroactive effective date at all, so services provided before the effective date may never be payable.
That is why the effective date on the approval letter matters as much as the approval itself. We match it against your schedule and hold or redirect claims for any visits that fall before it, instead of sending claims that are certain to deny.
Official source: eCFR: 42 CFR 424.521 (retrospective billing) (external site)
Frequently asked questions
How long does credentialing take?
It varies widely by payer, state and how complete the application is, and commercial plans often take longer than practices expect. Starting as soon as a provider signs is the most reliable way to avoid a gap. We share an estimated timeline for each payer when the application is submitted.
What is the difference between credentialing and enrollment?
Credentialing is the payer verifying a provider's qualifications: license, education, board status and history. Enrollment is getting the provider set up to bill that payer, including contracts, effective dates and linking the provider to the group. A provider usually needs both before claims will pay.
What is CAQH ProView and do we need it?
CAQH ProView is a shared database where providers keep credentialing information for the organizations that use it, and an expired attestation can stall applications and re-credentialing.
Official source: CAQH ProView provider quick reference guide (external site)
Can a new provider see patients before credentialing is finished?
They can see patients, but billing their services under another provider's NPI is generally not allowed. Narrow exceptions, such as Medicare's locum tenens and incident-to rules, have strict conditions and do not cover a new permanent provider.
Official source: CMS Medicare Claims Processing Manual, Chapter 1 (external site)
What happens if a Medicare revalidation deadline is missed?
Medicare can deactivate the provider's billing privileges, and claims for services during the lapse may not be payable once enrollment is reinstated. Tracking the due date and responding early avoids the problem.
Official source: eCFR: 42 CFR 424.540 (deactivation of billing privileges) (external site)
Related services and specialties
Related services
Insurance Eligibility Verification
Coverage, benefits, coordination of benefits and patient cost share confirmed before the visit, so claims start with the right payer.
Learn more about Insurance Eligibility VerificationRevenue Cycle Management
The whole cycle run as one process: patient access, coding, claims, payments, denials and patient balances, with shared KPIs.
Learn more about Revenue Cycle Management
Specialties
Mental Health Billing
Billing for therapy practices: psychotherapy time codes, group practice NPIs, telehealth, clinician credentialing and session authorizations.
Learn more about Mental Health BillingPhysical Therapy Billing
Timed therapy codes and the 8-minute rule, GP modifiers, KX thresholds, plan-of-care certification and visit limits.
Learn more about Physical Therapy BillingChiropractic Billing
Spinal manipulation codes, subluxation documentation, the AT modifier and maintenance care, plus cash and personal injury cases.
Learn more about Chiropractic Billing
Adding a provider or a location?
Talk to us before the start date, so applications are in progress while onboarding happens.