Claims denied as "provider not enrolled"
Out-of-network or non-participating denials mean a payer doesn't have you on file — and many won't pay retroactively.
We fix it: Enrollment + retro-billing review
Provider Credentialing & Payer Enrollment
Get Credentialed With Every Payer — and Start Getting Paid Sooner
Every week a provider isn't in-network is a week of denied claims and turned-away patients. We prepare, submit and chase your applications with Medicare, Medicaid and commercial payers, keep CAQH current, and track every renewal so you never fall out of network.
- All 50 states
- Medicare, Medicaid & commercial
- CAQH managed for you
- HIPAA compliant
Dr. Example — Enrollment TrackerLive
Illustrative example of the status reporting you'll receive
Medicare (PECOS)Approved
State MedicaidApproved
Blue Cross Blue ShieldContracting
UnitedHealthcareIn review
AetnaSubmitted
0missed renewals
We enroll providers with Medicare, Medicaid and commercial plans, including
MedicareMedicaidBlue Cross Blue ShieldUnitedHealthcareAetnaCignaHumanaTricareMolina HealthcareCentene / AmbetterOscar HealthMedicare Advantage plans
MedicareMedicaidBlue Cross Blue ShieldUnitedHealthcareAetnaCignaHumanaTricareMolina HealthcareCentene / AmbetterOscar HealthMedicare Advantage plans
Is this you?
6 Signs Your Practice Needs Credentialing Help Now
Credentialing problems rarely look like credentialing problems. They show up as denials, lost patients and revenue that never arrives.
A new provider starts soon
Commercial credentialing commonly takes 60–120+ days. Starting late means months of a new hire seeing patients you can't bill for.
We fix it: Start-date planning, parallel applicationsCAQH attestation lapsed
CAQH must be re-attested every 120 days. A lapsed profile can quietly freeze applications and re-credentialing.
We fix it: CAQH monitoring & attestationYou got a revalidation notice
Missing a Medicare or Medicaid revalidation deadline can deactivate your billing privileges and stop payments.
We fix it: Deadline tracking, on-time revalidationNew location, TIN or ownership change
Moves, new group TINs, mergers and new service locations all require payer updates before claims will pay correctly.
We fix it: Demographic & group updatesPatients ask "do you take my insurance?"
Every "no" sends a patient elsewhere. Missing key plans in your area limits growth more than marketing ever will.
We fix it: Payer-mix analysis & new enrollments
The cost of waiting
Credentialing Delays Are Revenue You Never Get Back
When a provider can't bill a payer, those visits are either turned away, written off or paid out-of-network. Slide the numbers to see what a delay could cost your practice.
Estimated revenue at risk
$52,800
Simple estimate: patients × reimbursement × days. For illustration only; your actual figures depend on payer, specialty and contracts.
What's included
Complete Provider Credentialing Services
From the first application to every renewal after it, one team owns the entire process.
01
Medicare Enrollment
Accurate CMS-855 applications through PECOS for individuals, groups and facilities.
- 855I, 855B, 855A & 855R
- Reassignment of benefits
- Revalidation & changes of information
02
Medicaid Enrollment
State-specific Medicaid and managed Medicaid plan enrollment in every state.
- State portal applications
- MCO plan credentialing
- Revalidation tracking
03
Commercial Payer Credentialing
Applications and persistent follow-up with national and regional plans.
- BCBS, UHC, Aetna, Cigna, Humana & more
- Medicare Advantage networks
- Weekly status follow-up
04
CAQH ProView Management
We build and maintain your CAQH profile so payers always see current data.
- Profile setup & document uploads
- Re-attestation every 120 days
- Payer authorization management
05
Re-Credentialing & Monitoring
We track every expiration date and renew before anything lapses.
- License, DEA & board certification
- Malpractice (COI) renewals
- Payer re-credentialing cycles
06
Contracting & Privileges
Support beyond enrollment so you're set up correctly from day one.
- Contract review & fee schedule requests
- Hospital privileging applications
- NPI, NPPES & demographic updates
How it works
Our 5-Step Credentialing Process
A clear, tracked path from intake to an active, effective contract.
1
Day 1
Free review
We audit current enrollments, CAQH and expirations to find gaps.
2
Week 1
Document intake
One secure checklist. We gather licenses, NPI, COI, W-9 and more.
3
Week 1–2
Applications filed
Complete, error-checked applications go to every target payer.
4
Ongoing
Relentless follow-up
We call and track each payer and answer their requests fast.
5
Approval
Effective & monitored
We confirm effective dates, load IDs, then track every renewal.
Why outsource
In-House Credentialing vs. Provider Concerns Solutions
Doing it in-house
- Staff pulled away from patients and billing
- Applications returned for missing items
- No one owns the follow-up calls
- Expired CAQH or COI discovered after denials
- Spreadsheets and sticky notes for deadlines
Recommended
With Provider Concerns Solutions
- Dedicated credentialing specialist for your practice
- Error-checked, complete applications the first time
- Scheduled follow-up with every payer
- Proactive alerts before anything expires
- Clear status reports — and billing handled by the same team
Who we credential
Credentialing for Every Provider Type
Physicians (MD/DO)Nurse PractitionersPhysician AssistantsGroup PracticesBehavioral HealthPhysical TherapyLaboratoriesHospitals & FacilitiesDental OfficesUrgent CareTelehealthDME Suppliers
0States covered
0+Specialties served
0Day CAQH cycle we monitor
0Team for credentialing + billing
What Is Medical Credentialing?
Medical credentialing is the process insurance companies and healthcare organizations use to verify that a provider is qualified to deliver care. Payers confirm your education, training, licenses, board certification, work history, malpractice coverage and claims history before adding you to their network.
It's often used interchangeably with payer enrollment, but there are two parts: credentialing verifies your qualifications, and enrollment/contracting sets up your participation agreement, fee schedule and provider IDs so claims can be paid. You need both to bill as an in-network provider.
Why Provider Credentialing Matters for Your Revenue
Without active enrollment, claims to a payer are typically denied or processed out-of-network. That affects more than one claim — it affects every visit with that payer's members until enrollment is complete.
- Cash flow: new providers can't generate in-network revenue until approved.
- Patient access: patients choose practices that accept their plan.
- Compliance: billing under the wrong provider or location can create audit risk.
- Growth: each added payer opens a new pool of patients.
Tip: Start credentialing 90–120 days before a new provider's first day. Many payers will not backdate effective dates.
Documents Needed for Credentialing
Gathering complete documents up front is the fastest way to avoid returned applications. We give you one secure checklist covering items like:
State medical license(s)
NPI (Type 1 & Type 2)
DEA & state CDS certificates
Board certification
Malpractice certificate of insurance
Updated CV with month/year work history
Education & training certificates
W-9 and group TIN details
Practice location & hours
Hospital affiliations / admitting arrangements
How Long Does Credentialing Take?
Timelines depend on the payer, state and application quality. Commercial payers commonly take about 60–120 days from a complete application, and some take longer. Government payers vary by Medicare contractor and state Medicaid agency. What you can control is submitting a clean, complete application and following up consistently — which is exactly what we do.
Common Credentialing Mistakes That Cause Delays
- Gaps in work history without explanation
- Addresses that don't match across NPPES, CAQH and the application
- Expired malpractice certificate or license uploaded
- CAQH not attested or payer not authorized to view the profile
- Missing signatures or the wrong application version
- No follow-up after submission, so requests for information go unanswered
Re-Credentialing and Ongoing Maintenance
Credentialing isn't one-and-done. Commercial payers commonly re-credential providers about every three years, Medicare requires periodic revalidation, and CAQH needs re-attestation every 120 days. Licenses, DEA registrations and malpractice policies all expire on their own schedules. We track every date and update payers before a lapse can interrupt your payments.
Because we also handle revenue cycle management, eligibility verification and denial management, enrollment issues are caught and fixed before they turn into lost revenue.
FAQ
Credentialing Questions, Answered
How long does provider credentialing take?
Most commercial payers take roughly 60 to 120 days from a complete application to an approved, effective contract, and some take longer. Medicare and Medicaid timelines vary by contractor and state. Submitting a complete, error-free application and following up consistently is the biggest factor you can control.
Can I see patients before I am credentialed?
You can see patients, but claims to a payer you are not yet credentialed with are usually denied or paid out-of-network. Some payers allow limited retroactive billing; many do not. Starting credentialing 90 to 120 days before a provider's start date is the safest approach.
What is CAQH and why does it matter?
CAQH ProView is the database most commercial payers use to pull provider data for credentialing. Profiles must be re-attested regularly, typically every 120 days. An expired attestation or outdated document can stall applications and re-credentialing.
Do you handle re-credentialing and Medicare revalidation?
Yes. We track every expiration date, including licenses, DEA, board certification, malpractice coverage, CAQH attestation, payer re-credentialing cycles and Medicare revalidation, and complete updates before they lapse.
Which providers and practices do you credential?
We credential individual physicians, nurse practitioners, physician assistants, therapists, group practices, laboratories, hospitals, dental offices and other facilities in all 50 states.
Can you help if my application was denied or my panel is closed?
Often, yes. We review the denial reason, correct the application, and where a panel is closed we can prepare an appeal or exception request that explains network need, such as specialty, location or language coverage. Approval is always the payer's decision.
Stop Losing Patients and Payments to Credentialing Delays
Get a free credentialing review. We'll check your current enrollments, CAQH status and upcoming expirations, and show you exactly what's needed to get every provider in-network.
Get My Free Credentialing Review → +1 (737) 307-6107