Insurance credentialing services
Insurance Credentialing and Payer Enrollment Services
Our provider and medical credentialing services cover insurance credentialing, CAQH updates and payer enrollment, so new providers can start billing sooner. Existing providers keep their network status instead of losing it to a missed deadline.
What we manage
- Initial credentialing
- CAQH ProView upkeep
- Medicare, Medicaid and commercial enrollment
- Revalidation and re-credentialing
- Application follow-up
The problem
Why credentialing problems become billing problems
If a provider is not enrolled, or the enrollment lapses, claims are denied no matter how well they are coded.
How we handle it
Credentialing handled alongside billing
Because we also see the claims, we can spot enrollment issues from denial patterns and fix them before they spread.
- Provider data collection and document checklist
- CAQH ProView setup and re-attestation
- Payer application preparation and submission
- Follow-up until approval and effective dates are confirmed
- Linking providers to group contracts
- Address, location and taxonomy updates
- Expiration and revalidation calendar
- Enrollment-related denial review
Payer enrollment
Getting providers set up to bill each plan
Credentialing confirms a provider’s qualifications. Enrollment gets the provider into each payer’s system so claims can actually be paid. Both have to be finished, and kept up to date, before billing works.
Timelines depend on the payer and on how complete the application is. Enrollment often takes several months, which is why we start as early as possible.
- National Provider Identifier (NPI) details via NPPES
- CAQH ProView profile setup and regular re-attestation
- Medicare enrollment through PECOS (CMS-855 applications)
- State Medicaid enrollment (in Georgia, through GAMMIS)
- Commercial and managed care plan applications
- Group and individual provider linking
- Revalidation and re-credentialing tracking
- Application status follow-up with each payer
Process
How credentialing works with us
Collect
We gather licenses, certifications, history and practice details.
Apply
Applications are prepared and submitted to each payer.
Follow up
We track each application until it is approved.
Maintain
Re-attestations and revalidations are tracked on a calendar.
Why it matters
Why it pays to stay on top of enrollment
FAQ
Insurance Credentialing and Payer Enrollment Services: common questions
What is the difference between credentialing and payer enrollment?
Credentialing is the verification of a provider’s education, training, licensure and history. Payer enrollment is the process of joining a health plan so the provider can bill it. The terms are often used interchangeably, but both steps are needed.
How often does CAQH need to be updated?
CAQH ProView asks providers to re-attest their information every 120 days, and to update the profile whenever details change.
How long does credentialing take?
It varies by payer and by how complete the application is. Several months is common, so it is best to start well before a provider’s first patient day.
Related services
Services that work alongside credentialing
Let’s take a closer look at your revenue cycle
Tell us what’s getting stuck. Denials, old A/R, credentialing, reports nobody reads? We’ll look at how you work now and tell you straight what we’d change, and why.