Credentialing & payer enrollment
We prepare, submit and follow up on payer enrollment and credentialing for individual providers and groups, keeping every payer, product and location tracked separately.
Services within credentialing.
- 01
CAQH profile setup and upkeep
We build or clean up your CAQH ProView profile so payers find complete, consistent information, and keep re-attestation on schedule.
- 02
Commercial payer enrollment
Applications to commercial health plans for each provider, plan product and practice location you choose, tracked one by one until a decision arrives.
- 03
Medicare enrollment
Practitioner and organization enrollment, reassignment and changes of information through the route Medicare requires for your provider type.
- 04
Medicaid and managed care enrollment
State Medicaid enrollment and Medicaid managed care plan participation, handled as the separate steps each state requires.
- 05
Group enrollment and affiliations
Linking providers to your group with each payer, so every provider, payer and location combination is enrolled and recorded on its own.
- 06
Payer contracting
Support through the contracting step after credentialing: tracking offers, signatures, countersignatures and effective dates.
- 07
Primary-source verification tracking
A dated record of every verification behind an application: licenses, exclusions, NPI details and other items each payer asks for.
- 08
Recredentialing and revalidation
We watch your recredentialing and revalidation dates and prepare each one well before the payer's deadline.
- 09
Roster updates, location adds and terminations
Keeping payer records current as your practice changes: new locations, demographic updates, roster changes and provider terminations.
Not a guarantee of network acceptance or a substitute for an independent credentialing decision. Payers make all network and credentialing decisions, and requirements vary by payer, product, provider type and state.
Other services.
- 02
Licensing
New and growing agencies, facilities and programs: behavioral health, home care, outpatient and other licensed healthcare businesses.
- 03
Accreditation
Organizations preparing for CARF, The Joint Commission or another accrediting body.
- 04
Healthcare consulting
Founders, administrators and leadership teams who need an experienced partner for a defined project.
- 05
Revenue cycle management & billing
Practices and healthcare organizations that want help setting up billing, keeping claims moving or cleaning up old accounts receivable.
- 06
Staffing & workforce readiness
Agencies, facilities and practices hiring clinical or support staff, or preparing staff files for a survey or audit.
- 07
Ongoing managed services
Organizations that want renewals, revalidations and recurring reviews handled on a schedule.
Tell us what you're working on.
Share a few details and we'll follow up to talk through scope, timing and next steps. There's no obligation.