The whole credentialing workload. Handled on schedule.
From new-provider enrollment to CAQH management, Medicare and Medicaid revalidation, payer contracting, and monthly monitoring. Twelve service families, one accountable team.
What credentialing actually is, and why it decides whether you get paid.
Credentialing is how a payer confirms a clinician is qualified, licensed, and eligible to be reimbursed under the payer's contract. Until a provider is credentialed and enrolled, that payer will not pay for the provider's services, no matter how many patients are seen. It is the ignition switch for revenue.
Enrollment → Contract → Effective Date → Billable
Every payer wants slightly different things: NPI Type 1 and Type 2, CAQH attestation within the last 120 days, current malpractice certificate, W-9, state license, DEA where applicable, board certification, taxonomy code, hospital privileges, EFT/ERA setup, plus payer-specific application forms and supplements.
Once submitted, the payer verifies from primary sources, sends the contract, and issues an effective date. That effective date, not the submission date, is when claims start paying.
Silent revenue loss you only see 90 days later
- New provider billing gap. Average enrollment runs 90-120 days per payer. A physician seeing 20 patients a day sits on tens of thousands in unbilled revenue until the effective date lands.
- Missed revalidation. Medicare requires revalidation on a rolling clock. Miss the window and CMS deactivates billing privileges. Claims stop paying until reactivation completes.
- CAQH lapse. Attestation older than 120 days makes commercial payers hold or reject applications and claims. Fixing it is minutes. Catching it in time is the job.
- Directory / taxonomy mismatch. Different NPI, address, or taxonomy across payers creates in-network claim denials that look like clinical denials but are actually credentialing failures.
We serve two people at once: the owner protecting the business, and the admin running it.
Credentialing sits between the business and the operation. It affects revenue, hiring speed, and compliance risk, and it lives in the day-to-day of whoever manages the office. We report to both.
Revenue protected. Hiring accelerated. Compliance risk taken off your desk.
- New providers billable faster. We start enrollment before day one so a new hire's revenue window opens on schedule, not three months late.
- Recredentialing never lapses. Every Medicare, Medicaid, and commercial revalidation tracked on the payer's clock. Deactivation stops being a threat to cash flow.
- Payer contracts in your hands. Fee-schedule visibility, in-network status per provider per plan, and clean documentation for when you negotiate.
- Audit-ready without effort. Primary-source verification, license status, and expiration tracking maintained continuously, not scrambled together for a survey.
- One number to call. No juggling per-payer contacts, portal logins, or "who was handling this?" Every enrollment has an accountable owner on our side.
The queue that never overflows. The follow-ups that get made. The dashboard you can trust.
- No more chasing CAQH attestations. We monitor the 120-day clock for every provider and re-attest before it expires. Zero portal digging on your side.
- Applications actually move. Every open enrollment tracked with payer, rep, reference number, missing docs, and expected effective date. You get a weekly status, not "waiting on payer" for months.
- Directory errors caught early. We cross-check CAQH, NPPES, PECOS, Medicaid, and commercial payer directories. Mismatches surface before they start denying claims.
- Onboarding cost drops. New provider paperwork, CAQH build-out, and payer applications leave your desk. You get provider setup done in hours of your time, not weeks.
- A single dashboard. Provider-by-payer status, upcoming deadlines, expiring documents, and pending follow-ups, all in one monthly view you can share with the owner.
Provider lifecycle: enroll, maintain, re-credential.
Most payers require re-credentialing every 3 years. We track the calendar and start the process 6 months before deadline.
Initial Enrollment
Timeline: 4-8 weeks depending on payer complexity.
What we do: Collect provider info, verify credentials, submit applications, follow up with payer. New providers are billable in 4-8 weeks, not 12.
Annual Maintenance
Timeline: Continuous, proactive.
What we do: CAQH profile updated annually. Address/license changes flagged within days. Payer rosters refreshed quarterly.
Re-Credentialing (3-Year Cycle)
Timeline: Started 6 months before deadline.
What we do: Applications re-submitted 60 days before expiration. No lapsed enrollments. Provider stays active.
License/Certification Updates
Timeline: Within 5 days of provider notification.
What we do: New license/DEA/specialty cert reported to payers. Enrollment stays current.
Twelve service families. Every enrollment scenario covered.
From first-time provider onboarding to ongoing monthly credentialing management. We run the whole workload so your providers stay billable and your enrollments never lapse.
1. Provider Enrollment
New-provider onboarding, application prep and submission, effective-date coordination across every payer you accept.
2. Payer Credentialing
Full-scope credentialing across Medicare, Medicaid, and commercial plans. One team, one workflow, per-payer expertise.
3. Medicare & PECOS Enrollment
CMS-855I and CMS-855B, PECOS reassignment, revalidation on the CMS clock. No deactivated billing privileges.
4. Medicaid Enrollment
State-by-state Medicaid enrollment, ID applications, revalidations, MCO participation. State rules handled per jurisdiction.
5. Commercial Payer Enrollment
Aetna, Cigna, UnitedHealthcare, Humana, BCBS, regional and employer-sponsored plans. Application through effective date.
6. CAQH Management
Profile creation, document uploads, annual re-attestation, expiration tracking. Your CAQH stays audit-ready year-round.
7. NPI & Provider Data
Individual (Type 1) and organizational (Type 2) NPIs, taxonomy updates, NPPES demographic corrections, ongoing maintenance.
8. Hospital & Facility Credentialing
Medical staff applications, privileges, facility enrollment (clinic, DME, home health, hospice, behavioral, therapy).
9. Payer Contracting
Contract requests and negotiation support, fee schedule review, renewals, amendments, termination and re-contracting.
10. Recredentialing & Revalidation
3-year payer recredentialing on our calendar, CAQH re-attestation, Medicare and Medicaid revalidation started 6 months out.
11. Maintenance & Monitoring
License, DEA, and certification expiration tracking. Address, group, and taxonomy changes reported to payers on time.
12. Audit & Consulting
Credentialing cleanup, data integrity audits, workflow design, SOP development, department setup for growing practices.
Every provider type. Every credentialing requirement.
Physicians, APPs, behavioral health, therapy, and facility credentialing all handled under one program.
Physicians
MDs and DOs across primary care, medical specialties, and surgical specialties.
Advanced Practice Providers
Nurse Practitioners, Physician Assistants, CRNAs, Clinical Nurse Specialists, Certified Nurse-Midwives.
Behavioral Health
Psychiatrists, Psychologists, LCSWs, LMSWs, LMHCs, LPCs, LMFTs, professional counselors.
Therapy
Physical, Occupational, and Speech-Language Therapists. Audiologists.
Other Licensed Practitioners
Chiropractors, Podiatrists, Optometrists, Dietitians, Registered Nurses, and other licensed practitioners.
Facilities
Clinics, ambulatory groups, laboratories, DME/DMEPOS suppliers, home health, hospice, behavioral-health and therapy facilities.
Beyond applications: the discipline that keeps you enrolled.
Credentialing is not just paperwork. It is a system of primary-source verification, cross-payer data consistency, and disciplined follow-up.
Primary Source Verification
Education, training, licensure, board certification, DEA, malpractice, work history. Verified from the authoritative source, not the resume.
CAQH & Payer Data Audit
Cross-check CAQH, NPPES, PECOS, Medicaid, and commercial payers for address, taxonomy, NPI, TIN, and affiliation mismatches.
Payer Directory Management
Verify your providers appear correctly in payer directories: name, specialty, location, network status, new-patient availability.
Application Follow-Up
Every open application tracked with payer, reference number, status, missing documents, and expected effective date.
Credentialing Dashboard
Monthly provider-by-payer status report. You always know who is enrolled where, and what recredentialing deadlines are coming.
Compliance Audit
Periodic sweeps of licenses, DEA, NPI, CAQH, Medicare, Medicaid, malpractice, hospital privileges, and group affiliations.
Credentialing tuned to specialty rules.
Every specialty carries its own taxonomy codes, payer expectations, and state licensing overlays. We handle the specialty layer, so you focus on care.
Credentialing questions
Stop worrying about credentialing deadlines.
We track every provider's enrollment timeline and re-credential before expiration so you stay billable.
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