Payer Enrollment Specialists

Medical Credentialing
Services That Get You
Enrolled Faster

Every day your practice isn't enrolled with a payer is a day of lost revenue. ProvidaRCM manages the entire credentialing and payer enrollment process, from CAQH to every major commercial and government payer, so you start billing without delay.

Start Credentialing Today
  • All 50 US States
  • Medicare & Medicaid
  • All Major Commercial Payers
  • Mid-Level Providers

The Cost of Not Being Credentialed

Average Revenue Lost Per Month of Delay

Solo Internal Medicine Physician

$18,000–$32,000

Cardiologist (Interventional)

$45,000–$80,000

Orthopedic Surgeon

$55,000–$95,000

Psychiatrist

$12,000–$22,000

Self-Managing

90–180

Days avg. to full enrollment

With ProvidaRCM

45–70

Days avg. to full enrollment

Why Credentialing Is Critical to Your Revenue

Medical credentialing is the process of verifying a provider's qualifications, education, training, licensure, and experience, and enrolling them as an in-network provider with insurance payers. Without it, you cannot bill that payer for services rendered to their members.

The credentialing process is notoriously complex, paper-intensive, and slow, involving multiple government portals, payer-specific applications, and constant follow-up. One mistake can delay your enrollment by weeks. ProvidaRCM handles it all.

Faster Enrollment — Start Billing Sooner

Our credentialing specialists know every payer's process, contacts, and common bottlenecks. We cut average enrollment time in half compared to self-managed applications.

Zero Application Errors

A single error on a credentialing application can delay enrollment by 30–60 days. Our specialists review every application multiple times before submission, zero rejection rate due to errors.

Ongoing Re-Credentialing Management

Payer credentials expire. CAQH attestations are required quarterly. We track every expiration date and handle all re-credentialing before your in-network status is at risk.

Full Transparency & Status Tracking

You always know exactly where each application stands. We provide regular status updates and alert you immediately when approvals are received so billing can start without delay.

Payers We Enroll With

ProvidaRCM handles enrollment with all major payers across every state and plan type.

Medicare Part A & B

Government

Medicaid All States

Government

BCBS

Commercial

Aetna

Commercial

UnitedHealthcare

Commercial

Cigna

Commercial

Humana

Commercial

Anthem

Commercial

Tricare

Military

45

Avg. days to enroll

+ 200 more payers across all 50 states — including regional Blues plans, managed Medicaid, Medicare Advantage, and workers' compensation programs.

Days avg. to full enrollment

Complete Credentialing
Services Covered

One flat fee covers the full credentialing lifecycle, from initial enrollment through ongoing re-credentialing and every update in between.

Initial Payer Enrollment

Complete enrollment applications submitted to all requested commercial payers, Medicare, Medicaid, and managed care organizations, with all supporting documentation gathered and submitted correctly.

  • New CAQH prProvider information packet collection and verificationofile creation and complete data entry
  • Payer-specific application forms completion and submission
  • Application tracking and payer follow-up until approval
  • Effective date confirmation and billing activation notification

Initial Payer Enrollment

Full CAQH ProView profile setup, completion, and ongoing attestation management. CAQH is required by nearly all commercial payers and must be attested quarterly, we manage it so you never lapse.

  • New CAQH profile creation and complete data entry
  • Document upload, license, DEA, malpractice, board certs
  • Quarterly attestation completion (required every 120 days)
  • CAQH profile updates for address, specialty, or group changes

Medicare & Medicaid Enrollment

Complete Medicare Part A and Part B enrollment including CMS-855 application completion, PECOS registration, and all state Medicaid program enrollments across all 50 states.

  • CMS-855I (individual) and CMS-855B (group/org) completion
  • PECOS (Provider Enrollment Chain & Ownership System) registration
  • State Medicaid enrollment in any/all 50 states
  • Medicare EDI, ERA, and EFT enrollment coordination

Hospital & Facility Privileging

Hospital medical staff credentialing and privileging applications for physicians who practice at hospital or ASC facilities, including primary source verification and peer reference management.

  • Hospital medical staff application completion and submission
  • Primary source verification coordination
  • Peer reference management and follow-up
  • Temporary privileges request during credentialing review

Re-Credentialing & Maintenance

Proactive re-credentialing management to ensure your in-network status never lapses. We track all expiration dates and initiate re-credentialing 90–120 days before the deadline.

  • Expiration tracking for all payer credentials
  • Re-credentialing application initiation 90+ days before expiry
  • License, DEA, and malpractice renewal reminders
  • CAQH quarterly attestation management

Demographic Updates & Changes

Any time your practice changes address, adds a location, hires a new provider, or changes ownership, we update all payers simultaneously to keep your credentialing current and accurate.

  • Address and location changes across all enrolled payers
  • Group practice additions and provider departures
  • NPI updates, specialty additions, tax ID changes
  • Ownership change notifications (required by Medicare)

Credentialing for
Every Provider Type

ProvidaRCM credentials every type of healthcare provider, from solo physicians to large multi-specialty groups and mid-level practitioners.

 

Physicians (MD/DO)

Full credentialing and payer enrollment for physicians across all medical specialties, from primary care to subspecialty surgical and procedural medicine.

Nurse Practitioners (NP)

Mid-level NP credentialing including state-specific scope of practice rules, collaborative agreement requirements, and Medicare supervising physician enrollment when required.

Physician Assistants (PA)

PA payer enrollment with correct supervising physician linkage, Medicare PA billing rules (85% of physician fee), and state-specific PA practice agreement requirements.

Behavioral Health Providers

Credentialing for psychologists, licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), and marriage and family therapists (MFTs) with all major commercial and Medicaid payers.

Physical & Occupational Therapists

PT, OT, and SLP credentialing including Medicare Part B therapy enrollment, outpatient therapy caps compliance, and commercial payer panel enrollment for therapy practices.

CRNAs & Anesthesiologists

Specialized anesthesia credentialing including CRNA supervision rules, anesthesia base unit billing setup, and enrollment with ASC and hospital facility payer contracts.

Week-by-Week Credentialing
Timeline

A transparent, step-by-step process that keeps you informed at every stage of your credentialing journey.

1

Week 1

Onboarding & Document Collection

We send you a secure, simple onboarding checklist to gather all required provider documents. Our team reviews everything for completeness and flags any missing items immediately.

2

Week 1–2

CAQH Profile Setup & Submission

We create or update your CAQH ProView profile with complete and accurate information, upload all required documents, and complete authorization for all requested payers to access your profile.

3

Weeks 2–3

Application Submission: All Payers

We submit enrollment applications to Medicare, Medicaid, and all requested commercial payers simultaneously, not sequentially, to compress the overall timeline as much as possible.

4

Weeks 3–8

Active Follow-Up & Status Tracking

We send you a secure, simple onboarding checklist to gather all required provider documents. Our team reviews everything for completeness and flags any missing items immediately.

5

Weeks 6–10

Approvals Received - Billing Activated

As each payer approves your enrollment, we immediately confirm the effective date, notify your billing team, and ensure your provider is set up correctly in your billing system before the first claim is submitted.

✓

Ongoing

Re-Credentialing & Expiration Management

We don't disappear after initial enrollment. We track every credential expiration date and initiate re-credentialing 90–120 days in advance, so your in-network status never lapses unexpectedly.

Self-Managing Credentialing
vs. ProvidaRCM

  • 90–180 day average enrollment timeline, staff spending hours on phone holds and portal navigation
  • High error rate on applications, incorrect or missing information delays approval by 30–60 days per error
  • CAQH attestations missed, provider's profile lapses, payers reject claims mid-billing cycle
  • No visibility into application status, weeks of silence from payers with no way to expedite
  • Re-credentialing deadlines missed, provider dropped from payer panels without warning
  • Demographic update delays, address changes not communicated to all payers, claims rejected
  • $30,000–$100,000+ in lost revenue per month of delayed enrollment

VS.

  • 45–70 day average enrollment timeline, dedicated specialists who know every payer's process and contacts
  • 100% application accuracy, every form reviewed multiple times before submission, zero rejection-due-to-error rate
  • Quarterly CAQH attestation managed automatically, profile always current, payers always have access
  • Weekly status updates on every open application, you always know exactly where things stand
  • Re-credentialing initiated 90+ days before expiration, in-network status protected at all times
  • Demographic updates pushed to all payers simultaneously, billing continuity maintained
  • Revenue flowing weeks faster, most clients recover the cost of credentialing in the first week of billing

Credentialing FAQs

Everything you need to know about outsourcing your credentialing
to ProvidaRCM. Don't see your question? Contact us directly.

Still have questions?

Our credentialing specialists are available to answer. We respond to all inquiries within one business day.

Talk to a Credentialing Expert

With ProvidaRCM managing your credentialing, most providers are fully enrolled with their primary payers within 45–70 days. Without professional management, practices typically experience 90–180 day timelines. Medicare enrollment specifically can take 60–90 days. We compress this significantly by submitting all applications simultaneously and following up proactively with each payer.

Yes. ProvidaRCM handles credentialing in all 50 states simultaneously. We are experienced with every state Medicaid program, state-specific licensing requirements, and regional payer enrollment processes. For practices adding new states or opening new locations, we handle the multi-state credentialing as one coordinated project.

CAQH ProView is a centralized database used by nearly all commercial insurance payers to collect and verify provider credentials. When you apply to a new payer, they pull your data directly from CAQH instead of requiring a separate application. Your CAQH profile must be complete, accurate, and attested every 120 days, or payers will no longer accept your credentials. ProvidaRCM manages your CAQH profile and all quarterly attestations as part of our service.

Yes. We credential all types of healthcare providers including NPs, PAs, CRNAs, psychologists, LCSWs, LPCs, physical therapists, and other mid-level and allied health providers. Mid-level credentialing has specific rules, including supervising physician requirements for Medicare and state-specific collaborative agreement rules, that our specialists handle correctly every time.

Rejections are rare when ProvidaRCM manages your application, our 100% pre-submission review catches errors before they reach the payer. If a payer issues a rejection for any reason, we respond immediately, identify the issue, and resubmit with corrections or supporting documentation at no additional charge. We handle the entire appeal and resubmission process.

We track every credentialing expiration date in our system and initiate re-credentialing 90–120 days before the deadline, well ahead of any payer’s required timeline. You receive advance notice with a simple document update request if anything needs renewing (license, DEA, malpractice). The re-credentialing application is submitted and tracked to completion, just like the initial enrollment.