Provider Enrollment & Credentialing FAQs

Provider enrollment is the process of getting a provider registered and approved to bill a health plan — Medicare, Medicaid, or a commercial payer — for the care they deliver. It covers the application, the payer's review and verification, and being added to the network so claims get paid. We handle it end to end.

Credentialing is verifying a provider's qualifications — education, training, licensure, and work history. Enrollment is registering that verified provider with a specific payer so they can bill and be reimbursed. You generally need both, and the two run together; we manage them as one process.

CAQH credentialing refers to setting up and maintaining a provider's profile in CAQH ProView — the online database most commercial payers use to pull a provider's credentialing information. Payers can't move your credentialing forward if the CAQH profile is missing, incomplete, or unattested, so we build it, attest it, and keep it current. Learn more on /services/caqh-credentialing/.

Most commercial payers take roughly 90–120 days, and Medicare enrollment through PECOS usually runs about 60–90 days — an overall industry range of 60–180 days (ranges reported by Verisys, EHR Source, and others). The exact timeline depends on the payer, the specialty, and how complete your file is. We keep every application moving, but approval dates are set by the payers and CMS, not by us.

Usually not. Most payers won't pay claims until a provider is approved and has an effective date, and retroactive billing is limited by each payer's effective-date policy and timely-filing rules — some allow limited backdating, many don't. Because revenue you miss during a delay is often gone for good, the safest move is to start early; we push every file to move as fast as the payer allows.

As early as possible — ideally 90–120 days before you need them billable, and sooner for complex specialties or a large payer mix. Since a provider generally can't bill until they're approved, every week of lead time protects revenue.

It's quoted per engagement — there's no single published price — because cost depends on your provider count and payer mix. For context, credentialing services across the industry commonly charge about $200–$500 to set up a provider and roughly $50–$200 per provider per month for maintenance (ranges reported by Medwave and credex). Tell us your situation on /pricing/ or via a quote request and we'll price it exactly.

No. Our pricing is transparent and quote-based, and no long-term contract is required — you stay because the work is good.

If a credential lapses, the payer can freeze the provider's file and deny or hold claims until it's corrected — and getting reinstated can mean redoing paperwork and losing billable time. The usual triggers are a missed CAQH re-attestation (required every 120 days) or a missed Medicare revalidation (required every 5 years) (per Relias and Verisys). Our credentialing maintenance service tracks these deadlines so your file never lapses — see /services/credentialing-maintenance/.

Yes — recredentialing is per-payer, not one-and-done. Each payer requires you to be re-credentialed on its own recurring cycle to stay in-network, and CAQH re-attestation is required every 120 days on top of that (per Relias and Verisys). Miss one and that payer can freeze your file, so we track every provider's renewals across every payer for you.

Yes. Ongoing maintenance — CAQH re-attestation, Medicare revalidation, recontracting, and expirable tracking — is a core part of what we do, and you can see every upcoming renewal on the PES platform (see /how-it-works/).

No. All of your credentialing is done in-house by our US-based team — your provider data and paperwork never leave the building and never go to a third party.

Solo and independent providers, small and mid-size group practices, facilities, ASCs, and newly independent physicians, NPs, and PAs. If you'd rather have credentialing handled than operate a software platform, we're built for you.