+1 (339) 365-2443 info@clainetrcm.com Boston, MA, USA

Expert Provider Enrollment & Credentialing Services

Streamline your healthcare practice with our comprehensive credentialing solutions. Get enrolled with insurance networks faster and focus on patient care while we handle the complex paperwork.

Comprehensive Credentialing Solutions

Our expert team handles every aspect of provider enrollment and credentialing, ensuring your practice gets approved quickly and maintains compliance with all requirements.

Provider Enrollment Services

Complete enrollment with major insurance networks and government programs including Medicare, Medicaid, and commercial payers.

  • Medicare Provider Enrollment (PECOS)
  • Medicaid Enrollment by State
  • Commercial Insurance Networks
  • Managed Care Organizations (MCOs)
  • Workers' Compensation Networks
  • TRICARE and Federal Programs

Medical Credentialing

Thorough verification and documentation of healthcare provider qualifications, licenses, and professional history.

  • Primary Source Verification
  • License and Certification Verification
  • Education and Training Verification
  • Work History and References
  • Hospital Privileges Verification
  • Malpractice Insurance Coverage

Re-credentialing Services

Ongoing maintenance of provider credentials and network participation to ensure continuous compliance.

  • Credential Renewal Management
  • License Expiration Tracking
  • Insurance Re-validation
  • Network Status Monitoring
  • Compliance Updates
  • Documentation Maintenance

Specialty Network Enrollment

Specialized enrollment services for various medical specialties and subspecialties with specific network requirements.

  • Behavioral Health Networks
  • Specialty Care Networks
  • Telemedicine Platforms
  • Value-Based Care Programs
  • Accountable Care Organizations
  • Direct Primary Care Networks

CAQH ProView Management

Complete management of your CAQH ProView profile to streamline the credentialing process across multiple networks.

  • Profile Setup and Optimization
  • Document Upload and Management
  • Regular Profile Updates
  • Attestation Management
  • Provider Data Synchronization
  • Network Application Facilitation

Credentialing Consultation

Expert guidance on credentialing strategy, compliance requirements, and optimization of your provider enrollment process.

  • Credentialing Strategy Development
  • Compliance Assessment
  • Network Selection Guidance
  • Timeline Planning
  • Problem Resolution Support
  • Best Practice Implementation

Our Proven Credentialing Process

We follow a systematic approach to ensure successful provider enrollment and maintain the highest standards of accuracy and compliance.

1

Initial Assessment

Comprehensive review of provider qualifications, practice needs, and target network requirements to develop a customized credentialing strategy.

2

Document Collection

Systematic gathering and organization of all required documentation including licenses, certifications, education records, and professional references.

3

Application Preparation

Meticulous preparation and completion of credentialing applications with attention to detail and accuracy to prevent delays.

4

Submission & Tracking

Timely submission of applications and proactive follow-up with credentialing organizations to ensure progress and address any issues.

5

Status Monitoring

Regular monitoring of application status, communication with credentialing committees, and resolution of any requests for additional information.

6

Approval & Maintenance

Final approval notification, contract negotiation support, and ongoing maintenance of credentialing status and network participation.

Why Choose Clainetrcm for Credentialing?

Our credentialing expertise and proven track record help healthcare providers achieve faster approvals and maintain compliance.

Faster Enrollment Times

Our experienced team knows the requirements and processes for each network, significantly reducing approval timeframes and getting you credentialed faster.

Higher Approval Rates

Meticulous attention to detail and comprehensive knowledge of credentialing requirements result in higher first-time approval rates and fewer rejections.

Reduced Administrative Burden

Focus on patient care while we handle the complex and time-consuming credentialing process, freeing up your valuable time and resources.

Expert Compliance Management

Stay compliant with ever-changing regulations and requirements with our ongoing monitoring and proactive credential maintenance services.

Cost-Effective Solutions

Avoid costly delays and rejections with our professional services that are more cost-effective than hiring in-house credentialing staff.

Personalized Support

Dedicated account management and personalized service ensure your specific needs are met and questions are answered promptly.

Proven Results You Can Trust

Our track record speaks for itself with industry-leading approval rates and client satisfaction.

95%

First-Time Approval Rate

60

Average Days to Approval

500+

Providers Successfully Credentialed

99%

Client Satisfaction Rate

Frequently Asked Questions

Get answers to common questions about provider enrollment and credentialing services.

The credentialing timeline varies by insurance network, but typically ranges from 60-120 days. Our streamlined process and expertise help expedite approvals, often achieving credentialing in 60-90 days for most networks.

Required documents typically include medical licenses, DEA certificates, malpractice insurance, CV, education certificates, board certifications, and references. We provide a comprehensive checklist specific to your specialties and target networks.

Yes, we provide ongoing re-credentialing services to maintain your network participation. We track expiration dates and proactively manage renewals to ensure continuous coverage without interruption.

Our high approval rate minimizes denials, but if one occurs, we immediately work to understand the reasons and develop a strategy for resubmission or appeal, providing ongoing support until successful approval.

Absolutely! We handle multi-specialty practices and multiple practice locations, ensuring comprehensive credentialing across all relevant networks and maintaining compliance for all locations and specialties.

Ready to Streamline Your Credentialing?

Let our credentialing experts handle the complex paperwork while you focus on providing excellent patient care. Contact us today for a free consultation and learn how we can accelerate your provider enrollment process.

Get Started Today