Credentialing, payer enrollment and contracting
Credentialing and enrollment, coordinated with your billing
Credentialing verifies a provider's qualifications; payer enrollment is the application that allows that provider to bill a specific health plan. The two are often confused, and neither guarantees that a payer will offer a contract or accept a provider into a network. We prepare and track every application, keep CAQH current, and make sure billing does not start before enrollment is effective.
Does this sound familiar?
- A new clinician starts seeing patients before they are enrolled with key payers.
- Applications sit with a payer and no one follows up.
- CAQH attestations lapse and claims start denying.
- Revalidation notices arrive and get lost.
Scope of work
Exactly what this service covers — and what it doesn't — so responsibilities are clear before you sign anything.
Included
- CAQH ProView profile setup, maintenance and re-attestation reminders
- NPI (Type 1 and Type 2) applications and NPPES updates
- Medicare enrollment and revalidation through PECOS
- State Medicaid and Medicaid managed care enrollment where available
- Commercial payer applications and follow-up through approval or decision
- Group roster additions, terminations and practice-location changes
- EFT and ERA enrollment coordination with each payer
- An enrollment tracker showing status by provider and payer
Not included
- Guaranteed network participation, contract offers or approval timelines — payers decide
- Rate negotiation on your behalf (we can prepare data to support your own negotiation)
- Hospital privileging
- State licensure applications
How the work flows
- 01
Provider intake
We collect licenses, certifications, education, work history, malpractice and identifiers through a secure process — never through this website.
- 02
Payer strategy
We confirm which payers matter for your patient population and which panels may be closed.
- 03
Applications
Applications are prepared, submitted and logged with reference numbers.
- 04
Follow-up
Each open application is followed on a set cadence until a decision is received.
- 05
Effective date
Billing is aligned to the effective date so services are not billed before enrollment.
- 06
Maintenance
Re-attestations, revalidations and roster changes are tracked going forward.
What we measure
Measured against your own baseline. We don't quote benchmarks or other clients' results.
- Open applications
- Applications submitted and awaiting a payer decision, by age.
- Time to decision
- Days from submission to payer decision, tracked by payer.
- Upcoming expirations
- Licenses, attestations and revalidations due in the next 90 days.
What we need from your practice
- Provider documents delivered through a secure channel we agree on
- Authorized official sign-off for group applications
- Access to, or authorization to manage, CAQH and PECOS profiles
- Patient information is exchanged only through secure access you control — never through forms or email on this website.
Credentialing, payer enrollment and contracting: common questions
Can you guarantee we will get in-network with a payer?
No one can. Payers decide whether to contract with a provider, and some panels are closed in certain areas. What we control is a complete, accurate application and consistent follow-up.
How long does enrollment take?
It varies by payer, state and application type, and payers change their processing times. We share realistic ranges for your payer list during the assessment and track actual time to decision for you.
Do you only do credentialing?
Credentialing is one part of our revenue cycle service. Many practices start with it while opening or adding providers, then move billing to us so enrollment and claims are managed together.
How do we send provider documents securely?
Through a secure file-sharing method agreed during onboarding. Please do not upload licenses, Social Security numbers or other personal documents through any form on this website.
Related services
- EDI, EFT and ERA setupClearinghouse connections and 270/271, 837, 999/277CA, 276/277 and 835 transaction setup.
- Practice launch and onboardingRevenue-cycle readiness, payer strategy, enrollment and go-live support for new practices.
- End-to-end medical billingCharge entry through payment — claims built, scrubbed, submitted and followed until resolved.
Primary sources
Content last reviewed . Payer rules change; this page is general information, not legal or coding advice for a specific claim.
Talk to us about credentialing, payer enrollment and contracting
Tell us where payments are getting stuck. In 20 to 30 minutes we'll show you what we'd check first, and tell you plainly if we can help.
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