A provider who can't bill a payer can't get paid by that payer — no matter how good the care was. Credentialing and enrolment is the paperwork-heavy, deadline-driven process that gets a physician recognized and in-network before day one, and keeps them that way.
What is Provider Credentialing & Enrolment?
Credentialing is the process of verifying a provider's education, training, licensure, and work history to confirm they meet a payer's or hospital's standards. Enrolment is the follow-on step of registering that credentialed provider with specific insurance payers — Medicare, Medicaid, and commercial plans — so claims billed under their name are actually payable.
Both processes depend heavily on an accurate, current CAQH profile, and both come with hard deadlines: missing a re-credentialing cycle can mean a provider is suddenly out-of-network without anyone noticing until claims start denying.
What credentialing gaps cost your practice
New providers unable to bill for months after start date
A lapsed re-credentialing date quietly dropping a provider out-of-network
A stale CAQH profile stalling every new payer application
Denied claims for services rendered before enrolment was effective
Every provider's re-credentialing date is tracked well ahead of the deadline — not discovered after a claim denies. We keep CAQH profiles current year-round so a new payer application never starts from zero.
How every provider gets enrolled
Gather provider documentation
Licenses, board certifications, malpractice history, and education records are collected and verified.
Build & maintain the CAQH profile
A complete, current CAQH profile is established as the foundation every payer application will draw from.
Submit payer applications
Applications are filed with Medicare, Medicaid, and each commercial payer the practice needs to be in-network with.
Track application status
We follow up proactively with each payer rather than waiting passively for an approval letter.
Confirm effective dates
Once approved, effective dates are confirmed and communicated so billing can start on day one of eligibility.
Monitor re-credentialing cycles
Every provider's re-credentialing deadline is tracked and renewed ahead of expiration, automatically.
Credentialing & enrolment services we provide
CAQH profile creation and ongoing maintenance
Medicare, Medicaid, and commercial payer enrolment
NPI registration and updates (Type 1 & Type 2)
Proactive re-credentialing tracking and renewal
Payer contract support during enrolment and renegotiation
