Can I see patients before credentialing is finished?

You can, but it is risky: claims for visits before your effective date with a payer are usually denied and are rarely recoverable, however clean they are. Some practices see those patients as self-pay until enrollment completes. Some payer contracts allow a new provider to bill under a supervising or already-enrolled provider for a limited period, and Medicare allows limited retroactive billing once enrollment is approved — but the rules differ by payer, state and arrangement, and getting them wrong can create repayment problems later. We read the contracts and enrollment terms you actually have and tell you in writing what yours permit, then confirm each effective date before the first claim to that payer goes out.

Do you work with practices that are just opening?

Yes. For a new practice, credentialing comes first — you cannot bill a payer you are not enrolled with — so we start with the CAQH profile and payer applications, then set up EDI, ERA and EFT with each payer so the first claim can go out electronically. You don't need an aging report to start; tell us your opening date and the payers you want to be in-network with.

Credentialing & Payer Enrollment Services

Why credentialing comes first

You cannot bill a payer you aren't enrolled with. Claims dated before your effective date get denied on timing alone, however clean they are — and they are usually unrecoverable. That is why credentialing is the first thing we work on for a new clinic or a new provider, and why it runs alongside billing for every practice we support.

What credentialing covers

We take every application through to a countersigned contract and a confirmed effective date.

CAQH profile build and re-attestation
PECOS / Medicare enrollment
State Medicaid and managed care plans
Commercial panels including BCBS, Aetna, Cigna and UHC
Group linkage, Tax ID and practice locations
Licence, DEA and malpractice expiry tracking

How long it takes

Typical enrollment takes about 150 days — roughly five months — from a complete document file to a confirmed effective date. Roughly three weeks of that is ours to control: building the CAQH profile and assembling documents. The rest is payer time: Medicare through PECOS commonly decides first, each commercial payer and Medicaid plan runs on its own clock, and contract execution usually lands between day 135 and day 150.

Start at least four to five months before you need to bill. Nothing begins until your documents are in hand, so the fastest thing you can do is send them early.

CAQH, PECOS and Medicaid: what each one is

CAQH ProView is the shared profile most commercial payers read your credentials from. It has to be complete, carry current documents and be re-attested every 120 days; an expired attestation quietly stalls every application that depends on it.

PECOS is Medicare's online enrollment system. Medicare enrollment links the individual provider to the group that bills for them, and Medicare revalidates enrollment on a cycle — miss the revalidation request and billing privileges can be deactivated.

State Medicaid programs, and the managed-care plans that administer Medicaid in most states, each enroll providers separately. A provider can be active with state Medicaid and still not be enrolled with the managed-care plan a patient is assigned to.

What we need from you

One encrypted file, collected once and reused for every application:

State licence, and DEA and state controlled-substance registrations where you prescribe
Malpractice certificate of insurance and claims history
Board certification, education and training history
CV with month-and-year dates and any gaps explained
W-9, NPI (individual and group), Tax ID and practice locations
Existing CAQH login, if you have one

Opening a new practice

For a new practice, credentialing is the critical path: every payer you want to be in-network with has to approve you before its patients' claims can be paid. You don't need an aging report to start — tell us your opening date and the payers you want, and we work backwards from it, then set up EDI, ERA and EFT with each payer so the first claim can go out electronically.

After you are enrolled

Enrollment is not a one-time event. CAQH re-attestation, Medicare revalidation, payer re-credentialing and licence, DEA and malpractice renewals all come back around. We track each expiry date and start the renewal before it lapses, because a lapsed credential produces denials that look like billing errors.

Our six-step process

CAQH profile audit — audited for gaps, or built from scratch
Document collection — one encrypted file: licence, DEA, malpractice, W-9, CV
File tracking — every application has an owner and a status
Application submission — all payers at once, because sequencing costs you months
Follow-up — contact with every payer every 7–14 days until a decision lands
Contract execution — effective date in writing before you bill

Commitments in writing

You get a named account lead, a written status on every open application, and a scheduled fortnightly status call. Credentialing is priced per application, and once you are enrolled we set up EDI, ERA and EFT with each payer so the first claim can go out electronically.

Provider credentialing and payer enrollment, through to an effective date

You cannot bill a payer you aren't enrolled with.

CAQH profile audit

Document collection

File tracking

Application submission

Follow-up

Contract execution