Get your providers on panels — and keep them there
Every week a provider sits un-enrolled is a week of unbillable clinical capacity. Credentialing is not hard work; it is relentless work — forms, verifications, portal quirks, follow-up calls and deadlines that never announce themselves. We do that relentlessly, so your providers start billing on the earliest date the payer allows.
A credentialing delay is a revenue delay
A physician who could be generating revenue but is not yet enrolled represents lost income that can never be recovered — the appointment slot does not come back.
The delays are rarely caused by payers being slow. They are caused by an application submitted with a missing malpractice certificate, a CAQH profile that lapsed attestation two weeks earlier, a work history gap nobody explained, or an application that has been sitting in a reviewer's queue for five weeks with nobody calling to ask about it.
Our credentialing specialists build files that are complete on first submission, then work the follow-up calendar until an approval letter with an effective date is in hand — and they tell your billing team the moment it lands so claims can go out immediately.
The six delays we eliminate
- Lapsed CAQH attestation. Re-attested on a 120-day calendar, never on a reminder email nobody opened.
- Unexplained CV gaps. Work history is reconciled month by month before a payer ever sees it.
- Expired documents. Licenses, DEA, malpractice and board certificates tracked with expiry alerts.
- Mismatched data. Name, tax ID, NPI, taxonomy and practice addresses reconciled across CAQH, PECOS and every payer record.
- Silent applications. Fixed follow-up cadence with logged reference numbers, not hope.
- Missed revalidations. Deadlines calendared 90 days ahead so a panel is never lost to an expired file.
Nine stages from new hire to fully enrolled
Each stage has an owner, a checklist and a follow-up cadence. You see the status of every provider against every payer at any moment.
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Stage 01
Provider Intake
A secure intake packet collects CV, licenses, DEA, board certification, malpractice coverage, diplomas, IDs and work history. We reconcile every date, chase what is missing and build a clean provider file before a single application is opened.
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Stage 02
CAQH ProView
Profile created or cleaned up, every document uploaded at the right version, practice locations and taxonomies aligned to your billing setup, payers authorized to access the record, and attestation completed — then re-attested every 120 days for as long as we work together.
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Stage 03
NPI Registration
Type 1 individual and Type 2 organizational NPIs registered or updated in NPPES, with taxonomy codes that match how you actually bill. Mismatched taxonomy is a quiet cause of enrollment rejections and we correct it before it costs you a cycle.
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Stage 04
PECOS
Medicare enrollment records built and maintained in PECOS: individual and group enrollments, reassignment of benefits, practice locations, EFT and ERA setup, and the surrogate access that lets us maintain the record for you without sharing personal credentials.
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Stage 05
Commercial Enrollment
Applications filed with the commercial plans that matter most to your patient mix — sequenced by revenue impact, not alphabetically. We pursue participation status, fee schedule visibility and a written effective date, and we escalate when a panel claims to be closed.
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Stage 06
Medicare
CMS-855I, 855B, 855R and 855S filed as your structure requires, tracked through your MAC to an approval letter with an effective date. We also handle reassignments, group additions, address changes and the five-year revalidation cycle that catches so many practices off guard.
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Stage 07
Medicaid
State Medicaid and managed Medicaid plan enrollment, including each state's own portal, ownership disclosure, site visit and screening requirements. We know these vary sharply by state — a process that takes three weeks in one state can take four months in another, and we plan your start dates accordingly.
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Stage 08
Hospital Privileges
Medical staff applications, primary source verification support, peer references chased politely but persistently, privilege delineation forms matched to your scope of practice, and submission timed to the credentialing committee calendar so you do not miss a meeting by three days.
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Stage 09
Maintenance
Credentialing never truly finishes. We run continuous maintenance: CAQH re-attestations, license and DEA renewals, malpractice certificate updates, payer revalidations, roster changes, demographic updates and exclusion list monitoring — with a monthly status report to your leadership.
Every credentialing service, and what it actually involves
Credentialing vendors love acronyms. Here is what each of ours means in practice.
Initial Credentialing
Everything required for a provider who has never been enrolled with a payer: file build, primary source verification support, application submission, and follow-up to an approved effective date. This is the work that determines when a new hire starts producing revenue.
Re-credentialing & Revalidation
Payers re-verify providers on their own cycle, usually every two to three years, and Medicare revalidates every five. Miss one and participation is suspended — claims deny until it is restored. We track and file every cycle before the deadline.
Payer Contracting
Enrollment gets you on the panel; the contract determines what you are paid. We request fee schedules, flag rates below regional benchmarks, and support renegotiation requests with utilization and quality data the plan cannot dismiss.
Group & Roster Management
For groups, the roster is the asset. We keep every provider, location, tax ID and effective date synchronized across payers, so claims route correctly and a departing provider is properly terminated rather than quietly left on file.
Telehealth Enrollment
Virtual-first groups face payer-by-payer telehealth policies, place of service rules and multi-state requirements. We enroll for the states you actually serve and keep a single tracker showing which providers are live where.
Exclusion & Sanction Monitoring
Monthly screening against the OIG LEIE, SAM.gov and applicable state exclusion lists for every provider and vendor on your roster — a payer and compliance requirement that practices routinely forget until an audit finds it.
How long each enrollment actually takes
We would rather set an honest expectation than a flattering one. These ranges assume a complete file at submission — which is exactly what our intake process is designed to produce.
| Enrollment type | Typical timeline | What drives the variance |
|---|---|---|
| NPI registration | 1–5 business days | Usually immediate; delays come from taxonomy or address mismatches |
| CAQH profile build & attestation | 3–10 business days | How quickly the provider returns documents and signatures |
| Medicare (PECOS / CMS-855) | 45–90 days | MAC workload, application type and whether a site visit is triggered |
| Medicaid (state plan) | 30–120 days | State portal requirements, ownership disclosure and screening level |
| Commercial payers | 60–120 days | Panel status, committee meeting frequency and contract negotiation |
| Hospital privileges | 60–150 days | Medical staff committee calendar and peer reference response times |
| Re-credentialing / revalidation | 30–90 days | Filed ahead of deadline so participation never lapses |
What changes when credentialing is handled properly
The gains are not abstract. They show up in start dates, claim acceptance and the hours your office manager gets back.
Faster revenue start
Providers begin billing on the earliest effective date a payer will grant, instead of weeks later because a file was incomplete.
Fewer enrollment denials
Claims denied because a provider was "not eligible on date of service" largely disappear when rosters and effective dates are accurate.
Audit-ready files
Complete, dated, version-controlled provider files with exclusion screening history — ready the day a payer or accreditor asks.
Confident expansion
Adding a provider, a location or a state stops being a bottleneck, because the credentialing runway is planned before you sign the lease.
Staff time returned
Your office manager stops spending afternoons on hold with payer credentialing departments and goes back to running the practice.
Better contracted rates
Fee schedules are reviewed rather than accepted, and below-benchmark rates are challenged with the data payers respond to.
Hiring a provider in the next 90 days?
Start credentialing now — every week of delay is billable capacity you cannot get backWhat practices ask us most
Need a specific payer or state answered? Call +1 (210) 568-8115.
Most commercial payers take 60 to 120 days from a complete submission. Medicare typically runs 45 to 90 days and Medicaid varies widely by state, from about 30 to 120 days. Hospital privileging follows the medical staff committee calendar and can add 60 to 90 days. Our job is to make sure none of that time is lost to a missing document, a lapsed CAQH attestation or an application sitting in a queue nobody is calling about.
It depends on the payer. Medicare permits retrospective billing for a limited window before the effective date in defined circumstances, and some commercial payers will backdate an effective date on request while others refuse outright. During intake we identify which of your payers allow retroactive dates, pursue them in writing, and tell you clearly where holding claims is safer than submitting them and risking a denial that is difficult to reverse.
A current CV with no unexplained gaps, state license, DEA registration, board certification, malpractice insurance certificate showing limits, diploma and residency or fellowship certificates, government photo ID, W-9, hospital affiliations, five years of work history, and immunization or health records where a hospital requires them. We send a secure checklist, collect everything in one place and chase what is missing so a single outstanding item never stalls the file.
Yes. We build or clean up the CAQH ProView profile, upload every supporting document, resolve mismatches between CAQH and payer records, authorize the right plans and re-attest on the 120-day cycle. A lapsed attestation is one of the most common — and most avoidable — reasons an otherwise perfect application is rejected.
New providers are added to the credentialing roster the day you tell us, and enrollment is sequenced so your highest-volume payers are approved first. Departing providers are formally terminated with each payer and removed from group rosters — a step practices frequently skip, which leaves claims and liability attached to someone who no longer works there.
Yes, and it is one of our most requested engagements. We run state licensing and payer enrollment in parallel across every state you plan to serve, track each payer's telehealth policy and place of service requirements, and maintain one consolidated tracker so you always know which providers can see patients in which states.
Sometimes. A closed panel is a business decision, not a permanent rule, and plans reopen when they have a network adequacy gap. We submit a network need argument built on your specialty, geography, languages spoken, after-hours availability and access times, and we re-submit on a schedule rather than accepting the first no. When a panel genuinely will not open, we tell you and we work the out-of-network path instead of leaving you waiting.
Send us your roster. We will tell you where you stand.
We will review your current enrollments, flag expired documents and upcoming revalidations, and give you a written plan with realistic effective dates for every provider and payer — at no cost.