Applying to the wrong plans
Every application costs time. Practices that apply everywhere spend months on plans with no membership in their county while the plans that matter wait.
Provider credentialing
Insurance Credentialing Services
Getting in network is a process with a dozen moving parts across every plan you want to bill. We run the whole thing, from choosing which panels are worth joining to loading the approved contract into your billing system.
Insurance credentialing at a glance
- Commercial, Blue, Medicare and Medicaid plans
- CAQH-based for most commercial payers
- Typical timeline: 90 to 150 days
- Contracts reviewed before signature
- Weekly status report per payer
- 90-150 days
- typical commercial panel timeline, tracked weekly
- Panel strategy
- we tell you which plans are worth the effort
- 2.29%
- starting rate when bundled with billing
The application path we run for this payer
- 1
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.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Insurance credentialing is the payer's review of your qualifications before it will contract with you and pay in-network rates. It touches CAQH, primary source verification, the payer's credentialing committee, and finally a participation agreement with a fee schedule. Each plan runs its own version, on its own timeline, with its own forms.
ClainetRCM manages the full cycle for every plan on your list. We start by mapping which payers actually hold membership in your area, so you spend effort on the panels that will send patients and skip the ones that will not.
Where this usually goes wrong
Nobody follows up
A submitted application is not a processed one. Without regular status calls, applications sit in a queue and quietly expire.
Contracts signed blind
The participation agreement includes a fee schedule. Signing without reviewing it locks in rates that may be below Medicare for years.
What ClainetRCM handles
One coordinator owns the file from intake to effective date.
- Payer mix analysis to prioritize the panels that matter in your market
- CAQH ProView setup, attestation and payer authorization
- Payer-specific applications for commercial, Medicare Advantage and Medicaid plans
- Weekly follow-up with each payer's credentialing department
- Contract and fee schedule review before you sign
- Provider IDs, effective dates and fee schedules loaded into your practice management system
The plans we credential with most often
Every market is different, but these are the panels that come up in nearly every engagement. Each has its own page with plan-specific detail.
| National commercial | Aetna, Cigna, UnitedHealthcare and Humana |
|---|---|
| Blue plans | Blue Cross Blue Shield licensees by state, Anthem and Regence |
| Government | Medicare, Medicaid, Medicare Advantage and Tricare |
| Regional and specialty | Local HMOs, behavioral health carve-outs, vision and dental plans as your specialty requires |
Questions about Insurance Credentialing
Most commercial plans take 90 to 150 days from a complete application to an executed contract. Government programs vary; Medicare is often faster, Medicaid managed care can be slower. Starting all panels at once, rather than one at a time, is the single biggest time saver.
State license, DEA and CDS certificates where applicable, board certification, malpractice face sheet, CV with no unexplained gaps, NPI confirmation, W-9, and hospital privileges if you have them. Our credentialing checklist lists everything by provider type.
You can, but claims will process out of network or deny, depending on the plan and the patient's benefits. Some plans allow billing under a supervising provider in limited situations. We advise on what is allowed for each payer while applications are pending.
Pricing depends on the number of providers and panels. Our credentialing is priced per provider per payer, and it is bundled at a lower rate for practices that also use our billing services. See credentialing cost and pricing.
Other payers and enrollment pages
Back to the provider credentialing overview, or continue with a related page.
Medicare Provider Enrollment Services
CMS-855 applications and PECOS filing
Medicaid Provider Enrollment Services
State Medicaid and MCO enrollment
PECOS Enrollment and Account Management
Medicare's online enrollment system
Medicare Revalidation Services
Cycle revalidation without deactivation
Medical billing services
Claims filed in 24 to 48 hours once you are in network
Who we serve
Practices, clinics, hospitals and facilities
Pricing
Credentialing and billing rates
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.