Credentialing that finishes, and stays finished.
Credentialing is not paperwork you do once. It is a calendar you keep. We run the applications, confirm the effective dates, and track the revalidation deadlines that quietly turn paid claims into write-offs.
- HIPAA Compliance Certified
- BAA signed with every client
- U.S. Wyoming LLC
- No setup fee
- No long-term contract
- Works inside your EHR
Most credentialing revenue is lost to a missed date, not a rejection.
Every provider, every payer, one calendar.
We treat credentialing as an ongoing obligation with dates attached, not a one-time submission. That is the difference between a provider who bills in network on day one and one who racks up 90 days of unbillable claims.
Four stages, then a calendar you keep.
Audit
We pull every provider, payer and effective date you already have, and find the gaps, lapses and revalidation dates nobody is tracking.
Prepare
Licences, DEA, malpractice, board certification, work history and W-9s collected once, verified, and kept in one place so no application stalls on a missing document.
Submit
CAQH built and attested, PECOS for Medicare, state Medicaid portals, and commercial panel applications filed per payer with the right group and tax ID linkage.
Track
Weekly follow-up on every pending application, effective dates confirmed in writing, and revalidation and re-credentialing dates calendared before they bite.
Every step, every payer, written down.
Plain guides from official CMS, CAQH and payer sources. Start with the checklist, then go to the payer you need.
Credentialing checklist
Every document and step for a new practice, with a free printable PDF.
How to get credentialed
Tax ID and NPIs, CAQH, Medicare, Medicaid and commercial contracts, in order.
How long it takes
The processing standards CMS publishes, and what slows other payers.
CAQH ProView help
Setup, authorizing plans, and re-attestation every 120 days.
Medicare credentialing
CMS-855 forms in PECOS, effective dates, revalidation and opt-out.
Medicare for therapists
Enrollment for counselors, MFTs, social workers and psychologists.
Credentialing for therapists
Commercial plans, Medicaid and Medicare for therapy practices.
ABA credentialing
BACB certification, Medicaid ABA enrollment and plan credentialing.
Blue Cross Blue Shield
Your local Blue plan, CAQH, BlueCard and the Federal Employee Program.
Nurse practitioners
Collaborative agreements, Medicare rules and commercial plans for NPs and PMHNPs.
Aetna credentialing
Aetna's request for participation, network need review and CAQH.
Cigna and Evernorth
Evernorth's provider information form, requirements and recredentialing.
Optum behavioral health
Provider Express paths, who qualifies and the mistakes Optum reports.
Free credentialing
Credentialing with 3 insurance payers at no cost for new billing clients.
Credentialing, answered plainly.
How long does provider credentialing take?
It varies by payer. Medicare is the only payer with published processing standards: CMS requires its contractors to process 95 percent of complete PECOS applications that need no site visit, extra information or fingerprinting within 15 calendar days of receipt. Commercial panels and state Medicaid programs set their own timelines, which vary widely, so ask each payer for its current turnaround. The clock only starts when the application is complete, so missing documents are the single biggest cause of delay.
Can I bill for a provider while credentialing is still pending?
Usually no. Most commercial payers will not pay claims with a date of service before the provider's effective date. Medicare allows retrospective billing for up to 30 days before the effective date only when circumstances prevented enrolling in advance. The safe approach is to hold those claims rather than submit and appeal, and to track the effective date per payer.
What is CAQH and why does it keep causing problems?
CAQH ProView is the shared credentialing database most commercial payers pull from. It requires re-attestation every 120 days. If attestation lapses, payers can stop pulling your data mid-application, which silently stalls credentialing and can affect existing contracts.
What is the difference between credentialing and payer enrollment?
Credentialing verifies the provider's licence, education, training, work history and malpractice record. Enrollment links that verified provider to a specific payer contract and tax ID so claims actually pay. A provider can be credentialed and still not be enrolled under the right group.
What happens if we miss a revalidation deadline?
Medicare can deactivate the billing privilege, which stops payment until it is reinstated, and reinstatement is not always retroactive. Commercial payers may move the provider out of network, which turns in-network claims into patient balances. Revalidation dates are the deadlines worth tracking hardest.
What is insurance credentialing?
Insurance credentialing is a health plan's check of a provider's license, education, work history, malpractice coverage and sanctions before the plan lets the provider join its network. It is followed by contracting, and a provider is in network only once the contract is signed and the effective date is confirmed.
How do I get a new physician credentialed with insurance payers?
Get the physician's individual NPI, license, DEA registration if needed, malpractice certificate and an attested CAQH profile in order, enroll them in Medicare and your state Medicaid program under your group, then apply to each commercial plan and confirm each effective date in writing. Our credentialing checklist for new practices lists every step.
Related reading
- Full-service RCM. Eligibility, coding, claims, denials and AR follow-up, end to end.
- Specialties we bill. Coding and payer rules across cardiology, OB-GYN, orthopedics, behavioral health and fertility.
- Prior authorization. The other payer process that stalls revenue, and what actually reduces the burden.
- HIPAA compliance. How provider and patient data is handled across our systems.
- How to get credentialed with insurance companies. Tax ID and NPIs, CAQH, Medicare, Medicaid and commercial contracts, step by step.
- Credentialing checklist for new practices. Every document and step as a tick-box list, with a free printable PDF.
- How long does insurance credentialing take?. The Medicare processing standards CMS publishes, and what slows other payers.
- Credentialing services for therapists. NPI, CAQH, payer applications and Medicare for counselors and MFTs.
- ABA credentialing services. BACB certification, Medicaid ABA enrollment and plan credentialing for BCBAs.
- Medicare credentialing services. CMS-855B, 855I and 855O in PECOS, effective dates, revalidation and opt-out.
- Free credentialing for new billing clients. Credentialing with 3 insurance payers at no cost when you start billing with us.
See it on your own behavioral health claims.
Eligibility verification (EV), benefits verification (BV), prior authorizations, and denial management at no cost for your first 30 days.
No setup fee. No long-term contract.