Articles & Resources
Plain-language guides on credentialing, payer enrollment, CAQH, and Medicare — from the team that does the work.
Can You Bill Insurance While Credentialing Is Pending?
In most cases you can't bill a payer as in-network until credentialing and contracting are done — and retroactive billing is limited. Here's what determines whether any of that waiting-period revenue is recoverable.
Read article →Credentialing Service vs. Credentialing Software: Which Do You Need?
Credentialing software is a tool your staff runs; a credentialing service is a team that does the work for you. For most small and mid-size practices, the deciding factor is who's actually going to do the work.
Read article →Credentialing vs. Enrollment: What's the Difference?
Credentialing verifies who you are and what you're qualified to do; enrollment sets up your ability to bill a payer. They're often used interchangeably, but they're two distinct steps — and you need both.
Read article →How Long Does Provider Enrollment Take?
Provider enrollment usually takes 90–120 days with commercial payers and 60–90 days for Medicare — roughly a 60-to-180-day range overall. What decides where you land is completeness, payer, and specialty.
Read article →What Happens If Your Credentials Lapse?
A lapsed credential or missed revalidation can freeze your payer file and turn claims into denials — and fixing it means starting a months-long process over. Here's how lapses happen and how to prevent them.
Read article →Value-Based Medicine and Its Impact on Credentialing & Contracting
Value-based care ties reimbursement to outcomes instead of volume — and that changes what payers look for in credentialing and how contracts are structured.
Read article →5 Keys to Selecting the Right Enrollment & Credentialing Partner
Picking the right enrollment and credentialing partner comes down to five things: real experience, comprehensive scope, flexibility, clear communication, and responsive support.
Read article →Provider Enrollment and Credentialing Services: A Complete Overview
Provider enrollment establishes your billing relationship with payers; credentialing verifies your qualifications. Here's what each covers and how a service handles both.
Read article →The Importance of Credentialing Services for Medical Practices
A dedicated credentialing service takes a complex, compliance-heavy process off your staff's plate — protecting revenue, keeping providers compliant, and freeing your team for patient care.
Read article →The Pros and Cons of Outsourcing Medical Credentialing
Outsourcing credentialing can cut administrative burden and cost while adding expertise — but it comes with trade-offs around control, communication, and data security. Here's how to weigh them.
Read article →How to Choose the Right Credentialing Service for Your Practice
Choosing a credentialing service comes down to five factors — experience and reputation, technology and process, cost, turnaround, and support. Here's how to weigh each.
Read article →Challenges of the Insurance Enrollment Process
Insurance enrollment stalls in three predictable places: getting through to the payer, understanding the contract you're offered, and outlasting a slow credentialing queue. Here's how to handle each.
Read article →Payer Enrollment First Steps: 5 Tips Before You Start
The insurance enrollment process is slow and unforgiving of shortcuts. Get these five things in place first — entity and banking, location, CAQH, malpractice, and contact details — and it moves far more smoothly.
Read article →TennCare & MedCost Now Using CAQH
TennCare and MedCost have adopted CAQH for credentialing and recredentialing — a welcome step, and part of a slow but steady move by more plans toward the shared CAQH database.
Read article →Provider Enrollment & Credentialing Specialist Positions
Our provider enrollment and credentialing team is growing, and we're often looking for enrollment coordinators and account managers. Experience helps — attitude and work ethic matter more.
Read article →How Credentialing & Insurance Enrollment Can Put You Out of Business
Credentialing sits at the starting gate of the reimbursement race. Get it wrong and the damage compounds — frozen claims, denial spikes, and a new hire who can't bill. Here's how it happens.
Read article →Medicare Non-Par vs. Opting Out: Don't Be Deceived
Becoming a non-participating Medicare provider is not the same as opting out. You still face audits, EHR rules, and limits on what you can charge — here's what non-par really means.
Read article →The Credentialing and Contracting Process Explained
The credentialing and contracting process has two distinct steps: credentialing verifies your qualifications (with CAQH feeding the data), then contracting sets how and how much a payer pays you. One doesn't work without the other.
Read article →Does Medicare Use CAQH?
No, Medicare doesn't use CAQH — it uses PECOS. CAQH is a commercial-payer credentialing database, though you can still use the information stored there to help complete Medicare applications.
Read article →CAQH Credentialing Made Easy
CAQH ProView is the shared profile commercial payers pull from during credentialing — and every provider needs one. Here's how the process works and how to keep it from stalling your enrollment.
Read article →Have a question these don't answer?
Talk to a US-based enrollment specialist — we'll give you a straight answer.
Provider Enrollment Services is a credentialing and payer-enrollment service; approval decisions and timelines are determined by the payers and CMS, not PES.