Credentialing & payer enrollment
Insurance credentialing services for providers and practices
We get your providers in-network with commercial payers, Medicare and Medicaid, and we keep them there. Credentialing starts at $80 per payer, you get a status update every week, and 5 commercial payers are credentialed free when you sign up for billing.
- From $80 per payer, plus packages and monthly plans
- 5 commercial payers free with billing
- Weekly status updates on every application
What we do
We handle credentialing from first application to re-credentialing
Credentialing is how a payer verifies a provider and agrees to pay them as in-network. We do the paperwork, the follow-up and the maintenance so your providers can see insured patients sooner.
A provider who is not enrolled cannot bill that payer as in-network. Most delays come from incomplete applications and applications nobody follows up on. We prevent both. A credentialing specialist with 15 years of experience leads the work, and you get a written status update every week until each payer is approved.
For one telehealth psychiatry client we have completed 100+ payer enrollments across 23 states. We credential solo providers, new group practices and growing multi-state teams in every specialty, with a core focus on psychiatry and behavioral health.
Commercial payers
Applications, follow-up and contracting with national and regional health plans, including behavioral health networks.
Medicare
Individual and group enrollment through PECOS, reassignment of benefits and revalidation.
Medicaid
State Medicaid enrollment plus credentialing with the managed care plans in each state.
CAQH ProView
Profile setup, document uploads, payer authorizations and re-attestation every 120 days.
Learn more →PMHNP credentialing
Taxonomy, state rules, DEA and multi-state telehealth enrollment for psychiatric NPs.
Learn more →Therapists and counselors
Getting LPCs, LCSWs, LMFTs and psychologists on insurance panels.
Learn more →Our process
How credentialing works, step by step
Every payer follows roughly the same sequence. We run each step for every provider and payer on your list.
- 01
NPI and taxonomy check
We confirm each provider’s Type 1 NPI and, for groups, the Type 2 NPI. We make sure the taxonomy code and addresses in NPPES match the license and the way you will bill.
- 02
CAQH ProView profile
We build or update the CAQH profile, upload current documents, authorize the right payers and attest. Most commercial payers pull their data from CAQH.
- 03
Payer applications
We choose the payers that fit your patients and location, then complete and submit each application with the supporting documents.
- 04
Follow-up
We check each application with the payer on a regular schedule, answer requests for information quickly and report progress to you weekly.
- 05
Contracting and effective date
Once credentialing is approved, the payer issues a contract or participation agreement. We confirm the effective date and your provider ID before you bill as in-network.
- 06
Re-credentialing and maintenance
We track license, DEA and malpractice expirations, CAQH re-attestation, Medicare and Medicaid revalidation and payer re-credentialing so no one drops out of network.
Payer types
Commercial, Medicare and Medicaid are three different processes
Each payer type uses its own system and rules. Knowing which one you are dealing with prevents most avoidable delays.
| Commercial payers | Medicare | Medicaid | |
|---|---|---|---|
| Where you apply | Payer portal or application, usually with CAQH ProView data | PECOS (CMS-855I for individuals, CMS-855B for groups, CMS-855R for reassignment) | Your state’s Medicaid enrollment portal, then each managed care plan |
| Uses CAQH? | Usually yes | No | Sometimes, for managed care plans |
| Can the network be closed? | Yes, panels can be full in some areas | No, eligible providers can enroll | State enrollment is generally open; managed care plans may limit networks |
| Contract and rates | Negotiated or set fee schedule per payer | Medicare Physician Fee Schedule | State fee schedule or plan rates |
| Upkeep | Re-credentialing, commonly every 3 years | Revalidation, generally every 5 years | Revalidation on the state’s schedule |
Rules vary by payer and state. We check current requirements before every application.
Timelines
How long credentialing usually takes
Most commercial payers take a few months from a complete application to an effective date. Government payers vary more by state and by contractor.
As a general range, commercial credentialing commonly takes about 60 to 120 days, and some payers take longer. Medicare enrollment is often faster when the application is complete. Medicaid timing depends heavily on the state and on each managed care plan.
We cannot control payer processing times, and no honest credentialing company can promise a date. What we control is submitting complete applications, answering payer requests quickly and following up on a regular schedule. Start credentialing well before a new provider’s first day, or before you plan to take a new insurance.
Pricing
Credentialing from $80 per payer
Pay per payer, choose a package, or use a monthly plan. When you sign up for billing, we credential 5 commercial payers free.
- Per-payer pricing starts at $80
- Packages for providers who need several payers at once
- Monthly plans for groups that add providers or maintain many enrollments
- 5 commercial payers free with billing. Government payers such as Medicare and Medicaid are not part of the free 5.
- Dedicated credentialer available by custom quote
- No long-term contract required
Common questions
How much do credentialing services cost?
Our credentialing starts at $80 per payer. We also offer packages and monthly plans. If you use our billing service, we credential 5 commercial payers free. Medicare, Medicaid and other government payers are priced separately.
How long does insurance credentialing take?
It depends on the payer. As a general range, commercial credentialing commonly takes about 60 to 120 days from a complete application, and some payers take longer. Medicare is often faster, and Medicaid varies by state. We follow up regularly and send you a status update every week.
What is the difference between credentialing and contracting?
Credentialing is the payer verifying your license, education, work history and insurance. Contracting is the agreement that sets your rates and effective date. You are in-network only when both are done, and we handle both steps.
Can I see patients before credentialing is approved?
You can, but claims may be paid out-of-network or denied until your effective date. Some payers allow a retroactive effective date and many do not. We confirm each payer’s effective date before you bill as in-network.
Do you credential in every state?
Yes. We work nationwide. For one telehealth psychiatry practice we have completed 100+ payer enrollments across 23 states.
What do you need from me to start?
Your NPI, state licenses, DEA registration if you prescribe, malpractice insurance face sheet, CV with month-and-year dates, education and board certification details, practice addresses, a W-9 and your CAQH login if you have one. We send a checklist and tell you exactly what is missing.
Do you handle re-credentialing?
Yes. We track expiration dates, keep your CAQH re-attestation current every 120 days and handle payer re-credentialing and Medicare and Medicaid revalidation, so providers do not fall out of network.
Guides from our team
Learn more before you decide
Anthem and Blue Cross Blue Shield: Credentialing and Billing for Mental Health Providers
How Blue Cross Blue Shield plans work for mental health providers: credentialing with Anthem in Georgia, BlueCard claims and common denials.
Read the guide →How to Get Paneled With Insurance as a Therapist: Steps, Timeline and Cost
How to get in-network with insurance as a therapist or counselor: what you need, how long it takes, what it costs, and what to do if a panel is closed.
Read the guide →Can LPCs and LMFTs Bill Medicare? How Counselors and MFTs Enroll
Since 2024, LPCs and LMFTs can enroll in Medicare. Who qualifies, how to enroll through PECOS, and how Medicare pays counselors and MFTs.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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