Effective billing management covers the entire credentialing and provider enrollment process — CAQH setup, Medicare/Medicaid enrollment, commercial payer contracting, and re-credentialing — so your providers start billing with all payers as quickly as possible.
Medical credentialing (also called provider enrollment) is the process of verifying a provider's qualifications and enrolling them with insurance payers so they can bill for services. It involves completing CAQH, submitting applications to each payer, and waiting for payer approval — which can take 90–120 days for commercial payers and up to 150 days for Medicaid. Delays in credentialing directly cost practices revenue for every day a provider cannot bill their patients' insurance.
We complete your CAQH profile from scratch or update an existing profile. CAQH attestation every 90 days to keep your profile current across all payers that require it.
Medicare enrollment via PECOS including individual provider enrollment (Form CMS-855I) and group enrollment (CMS-855B). Electronic submission for fastest processing.
State Medicaid enrollment for all states where your providers practice. We track state-specific requirements and timelines — Medicaid can take 90–150 days and has the strictest documentation requirements.
Participation applications to all major commercial payers in your market — Aetna, BCBS, Cigna, UnitedHealthcare, Humana, and regional payers. We track each application and follow up proactively.
We track all re-credentialing deadlines (typically every 2–3 years per payer) and initiate renewal 90 days before expiration. Missed re-credentialing = disenrollment and claim rejection.
Ongoing updates when provider information changes — new address, new license, new malpractice coverage, DEA renewal. Keeps your payer files current and prevents future denials.
We gather all required documents, complete CAQH ProView, and prepare all payer application packages simultaneously.
Medicare PECOS enrollment, Medicaid application, and all commercial payer applications submitted in the same window to compress total timeline.
We call and email each payer weekly to track status, provide missing documents, and escalate stalled applications. This is what separates fast credentialing from slow.
Medicare and faster commercial payers typically approve in this window. Provider can begin billing those payers immediately while remaining applications are pending.
Most commercial payers approved. Provider can now bill all payers. Medicaid approval may extend to Day 150 depending on state — we continue following up.
We don't wait for payers to call us. Weekly follow-up calls on every pending application. This alone cuts credentialing time by 30–45 days vs. passive submission.
150+ payers including all regional and specialty plans. State-specific Medicaid expertise for every state where your providers practice.
We identify which payers offer provisional billing with retroactive effective dates — protecting revenue during the credentialing window.
Automated reminders 90+ days before expiration. You never miss a re-credentialing deadline and risk disenrollment.
A provider who cannot bill insurance is not generating revenue — they're generating cost. Credentialing delays directly translate to lost revenue, often $10,000–$30,000 per month for a full-time provider during the waiting period. These five mistakes account for the majority of credentialing delays that extend that waiting period unnecessarily.
CAQH ProView is required by nearly every commercial payer before they will process a participation application. Starting CAQH after submitting applications means every payer sits waiting while the profile is completed — adding 2–4 weeks to every application simultaneously. The correct sequence is CAQH first, applications second. It's the single most common mistake in self-managed credentialing and the easiest to prevent.
Many practices submit to one payer, wait for the result, then submit to the next. Since each payer takes 90–120 days, sequential credentialing for five payers takes 12–18 months. Parallel credentialing — submitting to all payers simultaneously — compresses this to 90–120 days total. The documentation is the same; the only difference is whether you submit all at once or one at a time.
Most commercial payers require re-credentialing every 2–3 years. Missing a deadline results in temporary disenrollment — the provider is effectively uncredentialed with that payer until renewal is approved, and all claims submitted during the gap will be denied. Re-credentialing requires 90+ days of lead time; practices without a deadline tracking system will miss renewals. The revenue impact can exceed $50,000 per incident for a busy provider.
CAQH requires providers to re-attest (confirm their data is current) every 90 days. If attestation lapses, payers receive an "expired" status when checking the profile, which can stall active applications or trigger payer requests for updated credentials. This is a common silent delay — the application is moving, but the payer is waiting on CAQH attestation that nobody is watching. A credentialing management system should include automated CAQH attestation reminders.
Credentialing managed as a side task by a practice manager or front desk coordinator is almost always slower than dedicated credentialing management. Payer follow-up requires knowing each payer's specific contact path, portal access, and escalation process. Practices that assign credentialing to administrative generalists see timelines extend by 30–60 days on average, purely because the follow-up cadence is inconsistent. Dedicated credentialing specialists — in-house or outsourced — maintain the contact cadence that keeps applications moving.
Written & Reviewed By
Ajay — CEO, Aayur Solutions
17+ years in US medical billing and revenue cycle management across DME, behavioral health, dental, pain management, and multi-specialty practices. Founder of the American Billing Association resource hub. All content on ABA is written or reviewed against real billing operations — not keyword tools.
Every day without completed credentialing costs revenue. Start the credentialing process today — we can begin immediately.