Credentialing and Payer Enrollment
Your Provider Cannot Bill Yet. Credentialing and Payer Enrollment Come First.
A provider who is not enrolled with a payer is seeing patients you cannot bill for. Named specialists own each application end to end: they file with every payer on your list, keep the CAQH profile and attestations current, carry hospital privileging through appointment and reappointment, and start re-credentialing before a deadline quietly makes a provider inactive.
Enrollment Decides What You Can Bill at All
25+
Years of Healthcare Revenue Cycle Experience
Credentialing sits at the very front of the revenue cycle, before a schedule is built or a single code is chosen.
Not Enrolled, Not Billable
Until a provider is credentialed and enrolled with a payer, visits under that payer come back denied or cannot be billed at all. The care was delivered and documented, and the claim still goes nowhere.
A Lapse Reads Like a Denial
Re-credentialing dates and CAQH attestations pass quietly. Miss one and the provider goes inactive with that payer, so claims start denying on the provider record rather than on anything your coders did.
Every Payer Asks Differently
Each payer has its own forms, portals, rosters, and effective dates, and a group contract does not automatically cover a new provider. One missing signature sends an application back to the start of the queue.
A Named Specialist Owns Each Application, Start to Effective Date
One person on your account owns each provider's file. They collect the documentation once, build the payer list with you, file each application the way that payer wants it filed, and follow up until the payer issues an effective date. Nothing sits in a portal waiting for someone to notice it. Every deadline that follows is tracked on a calendar your account lead answers for: re-credentialing cycles, CAQH attestations, hospital reappointment. You get a status you can read rather than a folder you have to chase. It is the same accountability we bring to the rest of your medical billing services.
Initial Credentialing and Re-Credentialing
We take a provider from first application through approval, then keep the file current. Re-credentialing is started ahead of the due date, not after a payer letter arrives, so a provider who is already producing revenue does not go inactive between cycles.
Payer Enrollment, Commercial and Government
Enrollment with your commercial payers, Medicare enrollment through PECOS, and Medicaid enrollment through each state's program. That includes group enrollment and the NPI setup and payer linkage that make claims pay to the right entity. Each payer is worked to its own rules and its own effective date.
CAQH Profile Maintenance and Attestations
Payers read the CAQH profile, so we keep it accurate: documents refreshed before they expire, practice and roster changes entered when they happen, and re-attestation completed on schedule. An expired attestation stalls applications that were otherwise ready to approve.
Hospital Privileging, Appointment and Reappointment
We prepare and submit privileging applications to each facility, track them through the medical staff office, and carry the file through appointment and the reappointment cycle that follows. Providers who work across several facilities are tracked facility by facility, on each one's calendar.
Physician, Facility, and Behavioral Health Credentialing
Provider credentialing is the same discipline at very different scale: one new hire at a solo office, a class of providers joining a group, a facility carrying enrollment and medical staff privileging at once, a behavioral health roster of mixed provider types. Physician credentialing is the piece most people picture, and it is only part of what we file.
Physician Offices & Independent Practices
At a solo or independent office, one provider waiting on one payer is a visible hole in the schedule. We build the payer list, file each application, and track every effective date, the same way we run physician office billing.
Physician Groups & Large Practices
Groups onboarding several providers at once, across locations and entities, need each payer to add each provider to the group and link the individual NPI to the right billing entity. It is part of revenue cycle management for physicians.
Hospitals & Surgery Centers
Facilities run payer enrollment and medical staff privileging on parallel calendars, and a provider who works at several facilities is tracked at each one. We carry both alongside revenue cycle management for hospitals.
Added Scope, by Specialty
Behavioral Health Rosters
Behavioral health practices sit inside the three groups above and carry an extra problem: the roster mixes provider types (LCSW, LPC, PhD, MD) and payers credential and enroll each of them differently. We work the roster file by file, alongside mental health medical billing.
Credentialing and Payer Enrollment FAQs
What does credentialing and payer enrollment include?
It covers initial credentialing and re-credentialing, payer enrollment with your commercial payers, Medicare enrollment through PECOS, and Medicaid enrollment through each state's program (including group enrollment and the NPI setup and payer linkage behind it), CAQH profile maintenance and re-attestation, and hospital privileging from the application through appointment and reappointment. A named specialist owns each provider's file and follows it until the payer issues an effective date.
How long does credentialing take?
It depends on the payer, and every payer is its own clock. What moves it fastest is a complete file: current licensure and insurance documentation, an accurate and attested CAQH profile, the right group and NPI information, and a fast answer when a payer asks for something. What slows it down is outside anyone's control, including each payer's own review and committee cycle. We work each payer on its own timeline and tell you where each application stands rather than quoting you an average that your payers never agreed to.
Can you credential a new provider joining an existing group?
Yes. A group contract does not automatically cover a new provider, so each payer has to add that provider to the group, link the individual NPI to the group's billing entity, and issue an effective date. We build the payer list with you, file each one, track it to approval, and tell you where every application stands and which payers have issued an effective date.
Who tracks our re-credentialing and CAQH deadlines?
We do, on a calendar your account lead answers for. Re-credentialing is started ahead of the due date rather than after a payer letter arrives, CAQH re-attestation is completed on schedule, expiring documents are refreshed before they lapse, and hospital reappointment is tracked facility by facility. That is what keeps a productive provider from going inactive with a payer and turning clean encounters into denials.
How does credentialing fit with the rest of the revenue cycle?
Credentialing and payer enrollment sit at the very front of the revenue cycle, before scheduling, eligibility, and coding, because they decide whether a provider's work is billable at all. Because we run the rest of the cycle too, the same account lead answers for credentialing and for the billing that depends on it.