Provider Credentialing
Getting providers enrolled, and keeping that enrolment current.
Credentialing and payer enrolment decide whether a provider can bill at all. We prepare the applications, maintain the CAQH profile, track each payer's status in writing, and watch the revalidation and attestation dates that quietly push a provider out of network when they lapse.
Tools we work in
- CAQH ProView
- PECOS
- NPPES
- Availity
- Medallion
- payer enrolment portals
Works well with
Scope
What this covers
The specific work included when you engage us for this service.
- Payer enrolment applications for commercial, Medicare and Medicaid plans
- CAQH ProView profile setup and maintenance, with attestation completed on time
- NPI and PECOS record checks and updates
- Group and individual enrolment where a payer requires both
- Revalidation, re-attestation and demographic change tracking
- Hospital privileging paperwork coordination where the practice needs it
- Written follow-up on enrolment status until the payer issues a confirmation
What you receive
- 01A credentialing tracker showing each provider, payer, submission date and current status
- 02Completed applications and supporting documents, kept current in one place
- 03Calendar reminders ahead of every revalidation and attestation deadline
Questions
Provider Credentialing, answered
How long does credentialing take?
It is controlled almost entirely by the payer, not by us, and the range is wide. A commercial payer may complete enrolment in a few weeks, and others can take several months, with Medicare enrolment following its own processing order. We submit complete applications quickly and follow up in writing throughout, but we cannot accelerate a payer's internal review, and we will not pretend otherwise.
Can a provider bill while credentialing is still pending?
Usually not for the pending payer, with narrow exceptions. Some payers allow temporary or locum arrangements, and some overlapping arrangements let a new provider bill under an already-enrolled provider for a limited period. Whether any of that applies to you is a payer policy question, and we check it before the provider starts seeing patients rather than after the claims start denying.
What happens if we miss a revalidation?
The payer can deactivate the enrolment, and claims submitted afterwards are denied. Reactivating typically means resubmitting enrolment information and waiting through the process again. That is why we track every revalidation and attestation date explicitly, rather than relying on a letter that nobody opened or an email that went to a departed employee.
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