Credentialing companies price in one of three ways: a flat fee per provider per payer application, a monthly fee per provider that covers all payers and maintenance, or a bundled rate when credentialing is part of a billing engagement. Each model fits a different situation, and the cheapest quote is rarely the cheapest outcome if applications are returned or follow-up is skipped.
ClainetRCM prices credentialing transparently. You get a per-application quote for initial credentialing, a per-provider monthly rate for ongoing maintenance and re-credentialing, and a bundled rate starting at 2.29 percent of collections when we also handle your billing. There is no setup fee and no long-term contract.
Where this usually goes wrong
What is included in ClainetRCM credentialing pricing
Every engagement includes the following; nothing is added on later.
- Document collection, verification and gap review
- CAQH profile setup or cleanup and ongoing attestation
- Application preparation and submission for each payer
- Weekly payer follow-up until approval
- Contract and fee schedule review before signature
- Provider IDs and effective dates loaded into your billing system
- Status reporting on every open application
- Re-credentialing and revalidation calendar going forward
Pricing models compared
| Per application | A fixed fee per provider per payer. Best for a solo provider or a small practice adding a few panels. Includes follow-up through approval in our model. |
|---|---|
| Monthly per provider | A flat monthly rate covering all payers, maintenance, re-credentialing and revalidation. Best for groups and practices with turnover. |
| Bundled with billing | Credentialing included in the RCM engagement at a starting rate of 2.29 percent of collections. Best value when you need both. |
| Price drivers | Number of providers and payers, state Medicaid complexity, hospital privileging, cleanup of existing problems, and whether contracting negotiation is included. See payer contracting. |
For a quote based on your roster and target payers, request a free credentialing audit; the gap list doubles as the scope of work. Full pricing is on our pricing page.
How the work runs
The sequence is the same for every payer and provider type; what changes is which documents and portals each step touches.
- Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Frequently asked questions
How much does credentialing cost per provider?
Industry pricing for initial credentialing is typically a few hundred dollars per payer application, with monthly maintenance priced per provider. The exact figure depends on the payers, the state and the condition of the file. We quote after reviewing your roster so the number is accurate rather than a range.
Is credentialing cheaper if I also use your billing?
Yes. Practices that use ClainetRCM for billing get credentialing bundled into the RCM rate, which starts at 2.29 percent of collections with no setup fee. See pricing.
Are there any hidden fees?
No. Payer application fees, such as the CMS Medicare application fee for institutional providers, are passed through at cost and disclosed up front. Everything else is in the quote.
Can I do credentialing myself to save money?
You can. The forms are public and CAQH is free. The cost is staff time, learning each payer's process, and the revenue lost when an application is returned or forgotten. Most practices find outsourcing pays for itself with the first avoided delay.
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Or return to the provider credentialing overview.