If you're wondering, someone else has asked. Here are the questions we hear most often, answered plainly.
For most payers, the initial credentialing process takes 60 to 120 days from application submission. Medicare and Medicaid typically take 60 to 90 days. Commercial payers like Aetna, BCBS, and United can range from 60 to 120 days. Our process from intake to first application submission averages 30 to 45 days. The faster you get us your documents, the faster we can submit.
Most providers need: a current medical license, DEA certificate (if applicable), board certification, malpractice insurance certificate, CV or work history for the past 10 years, professional references, CAQH profile credentials, and NPI numbers (Type 1 and Type 2). We provide a complete checklist at intake so nothing is missed.
Most commercial payers require a CAQH profile. If you don't have one, we create it for you as part of onboarding. If you already have one, we verify it's complete and current before submitting any applications.
Yes, and we strongly recommend it. Credentialing can begin as soon as the provider is hired. Starting early prevents the gap between their start date and their first billable date.
You have real-time access to our client portal. Every provider in your practice has a dashboard showing their current phase (out of 7), payer enrollment statuses, document checklist, and any open action items. You never need to call us for a status update.
We handle it. Denials almost always have a fixable root cause: missing documentation, an error in the application, or a panel closure. We identify the reason, correct it, and resubmit. We stay on the appeal until it's resolved.
Credentialing is the verification process: confirming a provider's education, licenses, training, and malpractice history. Payer enrollment is the application to join a payer's network so the provider can bill that payer's members. Both need to happen, and we handle both.
Yes. We work with providers across multiple states and coordinate all state-specific licensing and payer requirements. Multi-state credentialing is common for telehealth providers and staffing agencies.
Credentialing is not one-time. Most payers require re-credentialing every 2 to 3 years, and individual licenses, DEA certificates, board certifications, and CAQH attestations all have their own expiration cycles. We track all of it and alert you 90 days before anything is due.
A lapsed credential can interrupt billing and trigger claims audits. If you're in our system, this shouldn't happen: we flag renewals 90 days out. If you come to us after something has lapsed, we do a credential recovery review and work to restore active status as quickly as possible.
Yes. We manage full recredentialing cycles, including updating CAQH attestations, re-verifying primary sources, and resubmitting payer applications on schedule.
Yes. Some clients use us as a full outsource. Others use us to support an internal team: handling overflow, specific payers, or complex situations. We work either way.
Reach out directly and we'll get you an answer fast.