Services · Credentialing & Payer Enrollment
Provider credentialing and payer enrollment services
Credentialing is the process of getting a provider approved to bill a payer; enrollment is the paperwork that makes it happen. Medicare typically takes 60–90 days, state Medicaid varies widely, and commercial payers commonly run 90–180 days.
Nothing bills until it is done, which makes credentialing the most expensive thing in a practice to get wrong. I handle applications, CAQH, follow-up, and the revalidation calendar that keeps it from lapsing later. Priced per provider per payer, plus monthly monitoring.
What I handle
- CAQH profile build and quarterly re-attestation
- Medicare enrollment and reassignment
- State Medicaid enrollment rules differ by state
- Commercial payer applications and contracting follow-up
- VA Community Care network applications
- Adding providers and adding locations to existing contracts
- Revalidation calendar with deadline alerts
- Roster maintenance and demographic updates
The failure everyone repeats
- Credentialing is treated as a launch task and then forgotten.
- A revalidation deadline passes, an enrollment goes inactive, claims deny for months before anyone connects it to the cause.
- By then timely filing has closed on much of it.
- The calendar is not an add-on to this service. It is the service.
What it costs
Per provider per payer, plus a monthly revalidation monitoring fee. Published on the pricing page.
Who this is not for
Practices needing hospital privileging or medical staff credentialing a different process handled by the facility.
State rules
Each state Medicaid program has its own name, portal, processing time, and revalidation cycle. For nurse practitioners, practice authority status determines whether a written practice or collaborative agreement must be in place first. Find your state →
FAQ
Questions and answers
Typically 60–90 days from a clean application. Errors and missing documents are the usual cause of longer timelines.
Generally no. Some payers permit retroactive effective dates; most do not. Do not assume it.
A centralized database most commercial payers pull credentialing data from. It requires re-attestation every 120 days, and a lapsed attestation stalls applications.
No. Approval is the payer's decision. I make sure applications are complete, accurate, and followed up.
Start with an assessment, not a contract
Two weeks, fixed fee, $2,500 to $5,000 depending on practice size. You get a written finding: where the money is going, what each leak is worth annually, and what it costs to fix. You own that report whether or not you hire me for anything after it.
Start with an assessment