Medical credentialing services
A provider who cannot bill cannot generate revenue. The credentialing process that stands between hiring a provider and collecting for their services takes 60 to 120 days with most payers. That gap costs practices between $6,000 and $8,000 per provider per month in unbilled revenue. We are a medical credentialing company built for that gap. Our physician credentialing services, provider credentialing services, and insurance credentialing services are integrated directly with your billing workflow so revenue starts the day the contract executes.
5-day onboarding | $0 setup | 50 states
Why credentialing delays cost more than most practices realize
A provider is ready to see patients. The schedule is full. The clinical team has completed onboarding. But until that provider is credentialed and enrolled with each payer, they cannot bill a single claim. Staffing costs hit your payroll immediately. Revenue activation follows 90 to 120 days later, if everything goes right.
according to an Intelliworx 2026 survey cited by NGAHealthcare. The single most important timing decision a practice makes is starting the credentialing process the day a new provider signs their offer letter, not their first day of work.
Claims submitted before enrollment completes are denied and cannot be recovered, which is why our AR recovery team flags these separately.
How long does credentialing take by payer?
NCQA rule changes effective July 2025 require monthly license checks, exclusion monitoring every 30 days, and credentialing windows of 90 to 120 days. A small discrepancy in NPI data, taxonomy codes, or CAQH profile can restart the clock instead of triggering a correction request.
What our healthcare credentialing services cover
Credentialing accuracy feeds directly into medical coding because a wrong taxonomy code on the NPI creates coding denials downstream.
CAQH ProView is the foundation of commercial payer credentialing. We build or update the profile, upload documents, authorize payers, and manage the mandatory 120-day re-attestation. A lapsed profile stops all connected enrollments.
We manage Medicare enrollment through PECOS using the correct CMS forms (855I, 855B, 855A). We also handle state-specific Medicaid applications and managed care plan enrollments separately, since each MCO requires its own application.
Applications submitted to BCBS, Aetna, UnitedHealthcare, Cigna, Humana, and regional plans. We follow up with payer credentialing committees weekly, tracking each file so stale applications do not close for inactivity.
Licenses, board certifications, DEA registration, malpractice history, education records, and work history verified directly against issuing bodies before any application goes out. One discrepancy caught here prevents a restart.
Medicare requires revalidation every five years. Most commercial payers require re-credentialing every two to three years. We track every expiration across your provider roster and initiate renewals before deadlines.
We coordinate applications for hospital admitting privileges and assist with payer contract and fee schedule review. Getting to contract is the finish line of credentialing. We do not stop at enrollment.
Our physician credentialing services: four-step process
We collect every required document: NPI details, active license, DEA registration, board certifications, education records, malpractice coverage, and complete work history. We verify each against the issuing source before the file moves.
Every credential verified directly with state medical boards, educational institutions, training programs, and malpractice carriers. Discrepancies resolved before payer submission, not after a rejection restarts the timeline.
Applications submitted electronically through payer portals or secure channels. We maintain weekly contact with credentialing committees and flag files at risk of going stale. A file nobody watches stops moving.
Once approved, we coordinate payer contract and fee schedule review before execution. We confirm the effective date with your billing team so claims begin on day one, not weeks after the contract is signed.
Healthcare credentialing services by provider type
Individual provider enrollments, group NPI linkage, hospital privileging, and cross-payer updates across multi-site practices. Surgical specialists and high-volume proceduralists face the longest timelines, so we flag those for parallel submission.
Insurance credentialing for mental health providers involves distinct panel requirements and licensure checks by payer. We manage enrollment for psychiatrists, psychologists, LCSWs, LMFTs, and counselors through our behavioral health billing workflow.
Advanced practice providers carry collaborative agreement requirements, supervising physician attestations, and incident-to versus direct billing rules that vary by payer. We manage the credentialing layer so billing rules are set correctly from day one.
Each new location requires its own NPI linkage, payer notification, and in some cases a fresh credentialing file. We manage the roster centrally so a provider credentialed at one location bills correctly at all locations.
The cost of managing credentialing in-house
The argument for outsourcing provider credentialing services is not staffing cost. Every week a payer enrollment sits unworked is a week of unbilled revenue. It is the revenue that stops moving when a credentialing file sits in a queue nobody is watching. A 30-day delay in enrollment costs more in lost billable revenue than a month of outsourced service.
For practices that also need coverage discovery, we run both under one engagement. Hospital-based providers face additional privileging steps that coordinate with our hospital billing workflow.
Medical credentialing questions we get asked
Direct answers for practices, groups, and hospital systems evaluating credentialing support.
Medical credentialing is the process by which payers and healthcare facilities verify a provider's qualifications, licenses, board certifications, education, and professional history. It is the required step before a provider can bill insurance as an in-network participant. Without completed credentialing, claims submitted under that provider's NPI are denied.
Credentialing is the verification phase: the payer confirms the provider is qualified. Provider enrollment is the contracting phase: the payer assigns a provider number and activates billing rights. Both must be complete before a provider can bill in-network. Most people use the terms interchangeably, but they are sequential steps, not the same step.
Medicare enrollment through PECOS takes 15 to 30 days for electronic submissions. Commercial payers typically take 90 to 150 days. Medicaid ranges from 45 to 90 days depending on the state. Delegated networks (Optum, Carelon) can take as long or longer than standard commercial plans. A complete, error-free submission with an up-to-date CAQH profile shortens the front end. Incomplete applications add 30 to 60 days.
CAQH ProView is the centralized database most commercial payers use to pull provider credentials. A complete, attested CAQH profile eliminates duplicate paperwork across payers. The profile must be re-attested every 120 days. A lapsed profile stops all connected commercial enrollments until re-attestation is complete. Providers also must explicitly authorize each payer to access the profile - forgetting this step delays enrollment even when the profile is current.
Core documents include: NPI (active, with correct taxonomy codes), state medical license, DEA registration, board certifications, malpractice insurance face sheet, education and training records, and complete work history with no unexplained gaps. Advanced practice providers also need collaborative agreements and supervising physician attestations. Incomplete applications are the leading cause of processing delays.
Re-credentialing is the periodic reverification of a provider's credentials after initial enrollment. Medicare requires revalidation every five years. Most commercial payers require re-credentialing every two to three years. NCQA standards effective July 2025 require more frequent monitoring: license checks monthly, exclusion checks every 30 days. Missing a re-credentialing deadline can result in disenrollment from all payers until the process restarts.
Yes, but they cannot bill as an in-network provider. Claims submitted before a contract's effective date are denied. Commercial payers do not adjust effective dates retroactively. Once those claims are denied, they cannot be recovered. This is why start date alignment between credentialing and billing is critical.
Request a free credentialing assessment. We review your current provider roster, open enrollments, CAQH profile status, expiring credentials, and payer mix - then deliver a written report with findings and a timeline. No obligation. You keep the report whether or not you work with us.
Your providers are ready. Get them billing.
A new provider on your payroll generates zero billable revenue until credentialing clears. Every week of delay is measurable lost income for your practice. As a medical credentialing company integrated with your billing team, we start the process the day you engage us, follow up weekly, and connect billing activation to contract execution so there is no gap between credentialing completion and the first clean claim.
Nationwide payer coverage · 48hr follow-up · NCQA + HIPAA compliant
Ready when you are
We review your current provider roster, open enrollments, CAQH profile status, expiring credentials, and payer mix, then deliver a written report with findings and a timeline. No obligation. You keep the report whether or not you work with us.
