Provider Credentialing Services for US Healthcare Providers
Get new and existing providers enrolled with Medicare, Medicaid and commercial payers. We handle the paperwork and the follow-up, so it doesn’t hold up your revenue.
A provider can’t bill a payer until they’re credentialed with it. A missing signature, an old CAQH profile or one wrong address can stall an application. Every stalled application is revenue you can’t collect yet.
We do the enrollment work for you. We prepare the applications, submit the documents and follow up with payers. When something is missing, we tell you exactly what we need.
Medicare
Medicaid
Commercial payers
Tell us about your providers and the payers you want to join. We’ll walk you through what’s involved.Talk to Us About Credentialing
We handle credentialing and enrollment for individual providers and groups. Here’s what that covers.
Payer Enrollment
We enroll providers with Medicare, Medicaid and commercial payers. We prepare each application carefully and check it against the payer’s requirements before it goes out.
Insurance Credentialing
We collect the documents each insurance network asks for and submit them for verification. Then we track the status until the payer makes its decision.
CAQH Profile Setup & Management
We set up new CAQH profiles and keep existing ones current. That way payers see accurate provider information when they look.
Provider Enrollment Follow-Ups
We check in with payers regularly to see where each application stands. If a payer asks for something, we take care of it and let you know if we need anything from you.
How it works
How to Credential a New Provider with Insurance
New provider? Credentialing has several steps, and each one has to be done right. Here’s how we get a new provider enrolled with payers:
New provider
Done: Step 01 We collect the provider’s information and documents.
Done: Step 02 We create or update the CAQH profile.
In progress: Step 03 We submit applications to each payer.
Next: Step 04 We follow up regularly to track progress.
Next: Step 05 The payer approves the application and enrollment becomes active.
The payer decides on approval. Our job is to send a clean, complete application and keep it moving.
Your part
What We Need from You
Part of the timeline depends on the provider. Payers wait on signatures, attestations and answers, and so do we. We track what’s still outstanding and remind you. You may need to:
Provide complete, accurate credentials and supporting documents.
Review, approve and sign enrollment applications.
Complete required disclosures and authorizations.
Authorize MedixCode to access and manage your CAQH profile.
Complete required CAQH attestations.
Answer questions about work-history gaps, disciplinary matters or adverse actions.
Take part in payer contracting decisions, interviews or required site visits.
Tell us when licenses, practice addresses, ownership, tax information or banking details change.
Timing
How Long Does Medical Credentialing Take?
Processing times are set by each payer, and they change. Other things that affect timing:
Whether the documentation is complete
Whether the application has errors
How quickly signatures and answers come back
We can’t promise a date. What we can do is send clean applications and follow up regularly, so your application doesn’t sit without anyone checking on it.
When there’s a problem
What Happens When a Credentialing Application Has a Problem?
When a payer flags an issue, we track it until it’s resolved. We can correct incomplete applications, request updated documents and answer requests for more information. We can also explain work-history gaps, fix mismatches between CAQH, NPPES, licenses and applications, and follow up on missing submissions.
If a payer panel is closed, or an application is rejected or denied, we record the status. Where the payer allows it, we help with resubmission, escalation, reconsideration or appeal. We also watch for credentials that expire while an application is under review. What we can do always depends on the payer’s rules and processes.
Full scope
What Our Provider Credentialing Services Include
We support credentialing and enrollment from a provider’s first application to their last day with a payer, including:
Initial Enrollment
Individual and group enrollment with Medicare, Medicaid and commercial payers.
Provider Additions
Adding providers to existing group and payer contracts.
Medicare Reassignment
Reassigning Medicare benefits to participating groups.
Medicaid Enrollment
State Medicaid enrollment and provider participation requirements.
Recredentialing and Revalidation
Tracking payer recredentialing cycles and Medicare revalidation deadlines. Medicare generally requires providers and suppliers to revalidate their enrollment every five years (DMEPOS suppliers every three years).
Location and Address Updates
Enrolling new practice locations and updating service addresses with payers.
Provider and Entity Changes
Ownership, tax ID, legal name and other enrollment changes.
Provider Terminations
Sending termination requests so payer records stay accurate.
NPI/NPPES Updates
Demographic and organizational updates in NPI and NPPES.
EFT and ERA Enrollment
Setting up or updating electronic funds transfer and electronic remittance advice.
CAQH Maintenance
Profile updates, re-attestation and documents.
Payer Directory Corrections
Finding wrong provider directory listings and asking payers to fix them.
Enrollment Appeals
Help with reconsiderations, corrections and appeals when the payer allows them.
Credentialing decides when a provider can start billing, so who handles it matters. We manage payer enrollment, insurance credentialing and CAQH profiles, and we keep provider information current with each payer.
We follow up with payers regularly, which helps us catch errors and missing items early. You get clear updates on where every application stands.
HIPAA compliant, with HIPAA-trained staff
AAPC/CPC Certified Coders and Billers
Work done in the EHR/PM system you already use, and your data stays yours
Pricing
Credentialing Pricing
From $200 per payer, per provider
Provider credentialing pricing
Service
Price
Commercial payer enrollment
$200per payer, per provider
Medicare enrollment
$250per provider
Group setup
$400per group
Credentialing maintenance
$35per provider per month
Billing clients
Billing Clients Get More
If MedixCode handles your billing, you get:
Free credentialing maintenance while your billing is active
Get a Written Credentialing Rate for Your Practice. Tell us how many providers you have and which payers you need. We'll give you a written rate.
Credentialing for Multi-Provider Practices
Credentialing several providers is harder when they work across different specialties, locations and payers. We’re multi-specialty, and we track each provider’s applications with each payer they need. After enrollment, we keep credentialing current so provider information stays up to date with each payer.
Provider credentialing is how payers verify a provider’s qualifications: education, training, licenses, certifications and work history. It confirms the provider meets the standards set by insurance companies and regulators.
Why is credentialing important for healthcare providers?
Credentialing is what lets a provider join insurance networks and get paid for their services. Without it, the payer can deny the provider's claims or pay them as out-of-network, which means lost or delayed revenue.
How long does the credentialing process take?
It depends on the payer. Each payer has its own processing times, so we can’t guarantee a date. Missing information or extra verification can add time.
What documents are required for credentialing?
Common documents include a valid medical license, a DEA certificate (if applicable), board certifications, malpractice insurance, a CV or work history, and identification. Requirements vary by payer.
How much does credentialing cost?
Commercial payer enrollment is $200 per payer, per provider, and Medicare enrollment is $250 per provider. Medicaid enrollment and CAQH profile work are priced in your written rate. Group setup is $400 per group, and credentialing maintenance is $35 per provider per month. Government and payer fees are separate. Enrollment fees are billed in two parts: 50% when we start the work and 50% when we submit the application. If MedixCode handles your billing, maintenance is free while billing is active, there's no group setup fee, and you get 10% off enrollment. More than 10 providers? Ask us for a written rate.
Can you guarantee that a payer approves my application?
No. Approval is always the payer’s decision. What we do is send clean, complete applications and follow up with the payer until it gives a decision.
How do you protect provider and patient information during credentialing?
We're HIPAA compliant, and our staff are HIPAA-trained. We work inside your existing EHR/PM system, and you keep ownership of your data.
Get Started with Provider Credentialing Today
Credentialing delays hold up payments, and they can keep patients from seeing a provider in-network. Let us handle the enrollment work so your staff doesn’t have to.
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