Medical Credentialing Services for Doctors and Medical Practices
Medicare, Medicaid, and commercial payer enrollment handled for you so you can start billing faster.
- HIPAA-Compliant
- U.S.-Based Experts
- Free Practice Audit
What Our Medical Credentialing Services Cover
Medicare and Medicaid Enrollment
We handle PECOS enrollment for Medicare and state-specific Medicaid enrollment for new providers and practices. This includes initial applications, revalidations, and updates when your practice information changes.
Commercial Insurance Credentialing Services
Getting paneled with commercial payers like Aetna, Cigna, UnitedHealth, Blue Cross Blue Shield, and others requires separate applications for each payer. We manage the full process across all the payers that matter most to your practice and patient base.
CAQH ProView Profile Setup and Maintenance
Most commercial payers use CAQH ProView to verify provider credentials. We set up your CAQH profile, keep it updated, and make sure your attestation stays current so payer applications go through without delays.
NPI Registration and Updates
We handle NPI Type 1 registration for individual providers and NPI Type 2 for group practices, as well as updates when your address, specialty, or group affiliation changes.
Re-credentialing and Ongoing Maintenance
Credentialing is not a one-time task. Most payers require re-credentialing every two to three years and many require ongoing updates to your profile. We track your re-credentialing deadlines and handle renewals before they become a problem.
New Provider Enrollment
Adding a new provider to your practice? We handle their full enrollment across all your existing payer contracts so they can start billing as quickly as possible.
How Our Medical Billing Credentialing Process Works
We streamline the process, but standard payer timelines still apply. Start early!
Document Collection
1-2 Weeks
We send you a checklist of everything we need: licenses, malpractice certificates, DEA registration, board certifications, work history, and more. Most providers can gather everything within one to two weeks.
Application Preparation
Accuracy First
We complete all applications accurately and thoroughly. The most common reason for credentialing delays is incomplete or incorrect applications. We review everything before submission to make sure nothing is missing.
Submission and Follow Up
30-90 Days
We submit to all requested payers and then follow up consistently throughout the review period. Payer timelines typically run 30 to 90 days. We stay on top of every application so nothing sits forgotten in a queue.
Approval and Confirmation
Success
Once your enrollment is approved we confirm your effective date, provider ID numbers, and contract details so your billing team has everything needed to start submitting claims immediately.
Typical Enrollment Timelines
These are typical ranges, not guarantees. Payer backlogs and incomplete applications are what stretch them.
| Payer type | Typical timeline | What it involves |
|---|---|---|
| Medicare | 30 to 60 days | Enrollment through PECOS using the CMS-855 applications, then revalidation every five years |
| Medicaid | Varies by state | A separate application for each state program, often with its own screening rules |
| Commercial payers | 60 to 90 days, up to 120 | A credentialing review that usually draws on your CAQH profile, followed by a participation contract |
| New provider joining your group | Depends on the payer | Linking the provider to the group's existing contracts and tax ID with each payer |
What You Need Before You Apply
Having these ready before the first application goes out is the single biggest thing that shortens credentialing.
Identifiers
Numbers and IDs
- NPI Type 1 for each provider
- NPI Type 2 and tax ID for the practice
- Medicare PTAN, if already enrolled
Credentials
Licenses and Certifications
- State medical license
- DEA registration, where it applies
- Board certification
- Malpractice insurance certificate
Background
History and Attestation
- Education and training history
- Work history, with any gaps explained
- A complete, attested CAQH profile
CAQH asks providers to re-attest every 120 days. A lapsed attestation quietly stalls commercial applications.
What Happens to Claims While You Wait
The question every new provider asks is whether they can see patients before credentialing is finished. The honest answer depends on the payer. Medicare can set your billing effective date as early as the day your application was filed, and generally allows billing for services up to 30 days before that date, so filing early protects revenue even while the application is pending.
Commercial payers are stricter. Most will not pay in-network rates for services delivered before the contract's effective date, and few will backdate it. Claims sent in that gap are denied or processed out of network, which is why we confirm each payer's effective date in writing before your billing team submits anything.
Until enrollment is approved, the safest path is to hold claims instead of sending them early, watch each payer's timely filing limit, and release them the day the effective date is confirmed. We coordinate that hand-off with whoever handles your billing, including our own medical billing team. For pricing, see our guide to what credentialing services cost.
Frequently Asked Questions About Medical Credentialing Services
The timeline depends on the payer. Medicare typically takes 30 to 60 days. Commercial payers generally run 60 to 90 days, and some can take up to 120 days for complex applications. Starting the process early is the most important thing you can do to minimize delays.
Yes. We work with new practices regularly. Beyond just credentialing, we help make sure your NPI, tax ID, and CAQH profile are all set up correctly before we begin the payer enrollment process.
Credentialing is the process of verifying your qualifications and enrolling you as a provider with a payer. Contracting is negotiating the fee schedule, the rates the payer will reimburse you for services. We handle both.
Pricing depends on the number of providers and payers involved. We offer flat-fee credentialing packages so you know the cost upfront with no surprises. Contact us for a quote based on your specific situation.
A lapsed re-credentialing can result in being removed from the payer's network, which means you cannot bill for services rendered to patients covered by that payer. We track your renewal dates and initiate the process well in advance to make sure this never happens.
Yes. We credential providers across all medical specialties including primary care, cardiology, mental health, physical therapy, dentistry, and more.
You can see patients, but whether you will be paid depends on the payer. Medicare can make your billing effective from the date your application was filed and generally allows billing for services up to 30 days before that. Most commercial payers only pay in-network rates from the effective date of your contract, so claims for earlier dates are denied or processed out of network.
CAQH ProView is the online profile most commercial payers use to verify a provider's education, licenses, work history, and malpractice coverage. An incomplete profile, or one that has not been re-attested in the last 120 days, is one of the most common reasons a credentialing application stalls.
Related Services
Medical Billing Services
End-to-end billing once you are enrolled
Revenue Cycle Management
The full cycle, managed as one process
Eligibility Verification
Confirm coverage before every visit
Prior Authorization
Approvals secured before procedures
AR Management
Recover claims held up by enrollment gaps
Small Practice Billing
Billing built for one to five providers
Medical Billing and Coding
Certified coding that holds up to payer review
MIPS / MACRA
Quality reporting for Medicare payments
Start Your Enrollment Today
Don't let paperwork hold up your practice. Let our experts handle the complexities.