Credentialing is where practices quietly lose money, and good medical credentialing services exist to stop that. If you are not in network the claim still goes out, still gets worked, and still does not get paid. One application can take three to six months when nobody is chasing it, and a single blank field sends it back to the start.
This is what we do best. Our medical credentialing services own the file from the first form to the approval letter, and we push the payer every week rather than waiting for a letter that may never come.
They are credentialing services for providers of every type, from doctor credentialing services for physicians and surgeons to nurse practitioners, therapists and dentists. That covers CAQH credentialing, payer enrollment services with Medicaid, commercial plans and Medicare (see our guide to Medicare provider credentialing), and re-credentialing when it comes due. Comparing prices? See what credentialing costs.
Credentialing by provider type
Credentialing is not one process. What a payer asks a dentist for has almost nothing in common with what it asks a behavior analyst, and the network that credentials a physical therapist is often not the health plan at all. Start with your provider type:
- Therapist & mental health credentialingLPC, LCSW, LMFT, psychologists and PMHNPs. Behavioral carve-outs, closed panels and the 2024 Medicare change.
- Dental credentialing servicesDelta Dental, MetLife, Cigna, Aetna and United Concordia. Associate linking and fee schedule review.
- Nurse practitioner credentialing servicesNPs and PAs. PCP panel requests, collaborative agreements and the Medicare 85% rule.
- Physical therapy credentialing servicesPT, OT and speech. Medicare private practice enrollment and the ASH and Optum networks.
- ABA credentialing servicesBCBAs, BCaBAs and RBTs. Agency enrollment, state Medicaid programs and roster management.
- Chiropractic credentialing servicesMedicare manual manipulation rules, ASH and Optum, plus workers comp panels.
- Telehealth credentialing servicesMulti-state licensing, the compacts, and payer enrollment state by state.
- Physicians and surgical specialtiesHospital privileges, ASC enrollment and group contracting. Tell us your specialty and we will scope it.
What is included
- CAQH profile built, attested and kept current on the CAQH ProView portal, including the 120-day re-attestation.
- Medicare and Medicaid enrollment through PECOS, including revalidation.
- Commercial panel applications with the plans your patients carry, filed to the correct network or carve-out.
- NPI and NPPES registration for new providers, new groups and new locations.
- Re-credentialing tracked and filed to NCQA standards before your dates expire.
- Contract and fee schedule review before you sign.
- Weekly status reports so you always know where each file stands.
How our credentialing process works
- Intake: we collect your documents once, through our secure document upload, and check them for gaps and expiry dates.
- CAQH: we build or repair your CAQH ProView profile, attest it and authorize each payer to view it.
- NPI and PECOS: NPPES details made consistent, and Medicare enrollment filed through PECOS where needed.
- Payer applications: filed with each plan you choose, on the right form for a new contract or a group addition.
- Weekly follow-up: every application chased with the payer every week, with a status report you can read.
- Contract review: the agreement and fee schedule checked before you sign.
- Effective date confirmed: in writing, with the tax ID it applies to, and your billing set up to match.
Documents you need to get credentialed
- State license, and any additional state licenses
- DEA and state controlled substance registrations, for prescribers
- Malpractice insurance face sheet showing limits and expiry
- Board certification, or proof of training if not yet certified
- CV in month and year format, with any gap over 30 days explained
- Individual and group NPI confirmations
- W-9 in the exact legal name on the tax ID
- Hospital privileges or an admitting arrangement, where your specialty needs one
- CAQH ProView login, if you already have a profile
- Practice locations, billing address and bank details for electronic payment
Credentialing vs enrollment vs privileging
- Credentialing The verification of your qualifications: license, education, training, work history, malpractice cover and sanctions.
- Enrollment Also called contracting: joining a payer's network under an agreement with a fee schedule, so your claims are paid as in network.
- Privileging A hospital or surgery center approving what you may do in its facility.
Passing credentialing does not make you in network. That only happens when the agreement is signed and the effective date is set.
How long credentialing takes
With CureCloudMed most credentialing finishes in one to three months, counted from the day we have a complete file. Medicare usually lands in 15 to 30 days, state Medicaid and commercial panels in 60 to 90, and adding a provider to a group you are already contracted with in 30 to 60. A few state Medicaid programs and commercial committees run slower than that; if yours is one of them, we tell you at the start.
Two things cause most avoidable delay: a CAQH attestation that lapsed mid-application, and a gap in the work history that nobody explained. We remove both before the file goes out.
For the payer-by-payer breakdown, where the weeks actually go and what shortens them, read our guide: how long does credentialing take?
What credentialing costs
We quote per provider per payer, and discount it when you also use our billing. The price depends on how many providers and payers you need, the payer types, whether the group itself is new, and the state of your CAQH profile. See how much credentialing costs for what drives the price, or get a free credentialing check for your own figure. New to the process? Start with how to get credentialed with insurance companies.
How to choose a credentialing company
Ask every company you are considering the same five questions:
- Who follows up with the payer, and how often?
- Is the price per provider and per payer, in writing, before anything is filed?
- Who maintains CAQH attestation and re-credentialing after you are approved?
- Do they chase the signed contract and effective date, or stop at the approval letter?
- What does their status report show, and how often do you get it?
Our guide to the best credentialing services compares the main options honestly, including doing it yourself.
Medical credentialing in Virginia, DC and Maryland
We are based in Fairfax, Virginia, so the Virginia programs are the ones we work in most. Virginia Medicaid is enrolled through the Department of Medical Assistance Services first, then with each Medicaid managed care plan separately. Practices near the DC line often need Maryland and District of Columbia enrollment as well, and each is a separate program with its own rules. See the Medicaid credentialing guide. We credential providers in more than 30 states, so the same process applies wherever you practice.
Groups, new practices and hospital privileges
- New practices group NPI, tax ID and every payer contract in place before opening, which means starting four to six months ahead.
- Adding providers a new clinician joining an existing contract is usually a roster add or link, not a new application.
- Multiple locations each location has to be registered with each payer, and some payers contract by location.
- Larger groups roster submissions and delegated credentialing, where the plan lets the group credential its own providers.
- Hospitals and surgery centers facility privileges and enrollment for ASCs.
Payer credentialing guides
How each major payer's credentialing actually works, who owns the network, what the timeline really is, and what causes the delays. Written for providers, not for search engines.
- BCBS credentialingWhy each state plan is a separate application, what BlueCard means, and who owns the behavioral network.
- UnitedHealthcare & OptumWhen Optum credentials you instead of UHC behavioral health and physical health networks.
- Medicare enrollment (PECOS)CMS-855 forms, reassignment, retrospective billing and the revalidation that stops payments.
- Aetna credentialingCAQH-driven, in-house behavioral health, and the network need review that comes first.
- Cigna & EvernorthMedical goes to Cigna, behavioral goes to Evernorth. Applications to the wrong one are not forwarded.
- Medicaid enrollmentThe state program first, then every managed care plan separately, including the Virginia process.
- Delta Dental credentialingMember companies, the PPO and Premier tier decision, and associate linking.
- Choosing a credentialing serviceAn honest comparison of the options for therapists, including when not to hire anyone.
Credentialing and billing together
Most companies do one or the other, so your panels and your claims fall out of step and you end up billing a payer you are not yet in network with. Here the same team owns both, and the first clean claim goes out the week your effective date lands.
- Revenue cyclemedical billing services claim submission, denial work and aged AR recovery.
- By specialtybilling services by specialty 50+ specialties, each with its own coding rules.
Medical credentialing FAQs
How long does medical credentialing take?
Filed without anyone following up, an application often takes three to six months. With CureCloudMed the usual range is one to three months, counted from the day we have a complete file. The delay is rarely the payer itself. It is a missing document, an old CAQH attestation, or nobody following up. We keep the file complete and chase it weekly.
What is CAQH and why does it matter?
CAQH ProView is the shared profile most commercial payers pull your credentials from instead of reading each application from scratch. It has to be complete and re-attested every 120 days. A lapsed attestation stalls every application you have in flight, silently.
How much does credentialing cost?
It is quoted per provider, per payer, because that is how the work scales. Bundled with billing the credentialing rate drops. You get the quote in writing before any work starts.
Can I bill while my application is pending?
Not as in-network. Some payers backdate to the application date and some do not, and that difference can be worth thousands. We ask for a backdate in writing on every application.
What is the difference between credentialing and contracting?
Credentialing is the payer verifying who you are. Contracting is signing the participating provider agreement and its fee schedule. You can pass the first and still not be in network because nobody countersigned the second, which is why we chase the executed contract rather than the approval letter.
Do you handle re-credentialing?
Yes, and we track the dates rather than reacting to them. Re-credentialing is usually a three-year cycle, and it is also triggered by a new location, a new tax ID, an ownership change or a change of practice name.
What documents are needed for credentialing?
Your license, DEA if you prescribe, malpractice face sheet, board certification, a CV with month and year dates, NPI confirmations, a W-9 and practice details. The full list is above.
How often is re-credentialing needed, and what if I miss it?
Commercial payers usually re-credential every two to three years, and Medicare revalidation comes round every five years for most providers. Miss it and the payer can end your participation or stop payments, which is why we track the dates.
Do you handle Medicare and Medicaid enrollment?
Yes. Medicare through PECOS, including reassignment to a group and five-year revalidation, and Medicaid with the state program and then each managed care plan.
Can you credential groups and multiple locations?
Yes. We set up group contracts, add providers to them, register each location with each payer and manage rosters for larger groups.
How do I choose a credentialing company?
Ask who follows up and how often, whether pricing is per provider and per payer in writing, who maintains CAQH afterwards, whether they chase the signed contract and what their reporting shows.
Free credentialing check
Tell us your provider type, your state and the plans your patients carry. We will tell you which panels are open, which are worth the paperwork, and how long each one should take.
Free credentialing check Talk to a credentialing specialist