Wrong Medicare enrollment type
A PT clinic enrolled as an individual when it should be a group, or as a group when it operates as a rehab agency, faces claim rejections and a difficult correction.
Provider credentialing
Physical Therapy Credentialing Services
Physical therapists enroll with Medicare individually or as a group practice, are credentialed by commercial plans directly or through physical medicine networks, and face state-specific Medicaid rules. We handle PT credentialing for solo therapists, groups and outpatient rehab facilities.
- Individual, group or rehab agency model
- Medicare through PECOS
- Networks: Optum Physical Health, ASH
- PTAs rostered, not credentialed
- CQ modifier configured for Medicare
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
Medicare enrollment for physical therapy depends on the practice model: therapists in private practice enroll as individuals or as a PT group, while rehab agencies and hospital outpatient departments enroll as facilities. Commercial plans may credential PTs directly or route them through networks like Optum Physical Health and ASH. Physical therapist assistants are not credentialed but must be documented for supervision and billed with the correct modifier.
ClainetRCM sets up the right enrollment model for your practice, credentials every PT with every payer, and configures the practice so PTA services and plan of care requirements are handled correctly from the first claim.
Where this usually goes wrong
Physical medicine network detours
Applying directly to a plan that delegates PT to a network means waiting for a redirection. Knowing the routing saves weeks.
PTAs and the CQ modifier
Medicare pays services furnished in whole or in part by a PTA at a reduced rate and requires the CQ modifier. Practices that never set this up are paid incorrectly or flagged on audit.
What ClainetRCM handles for you
One coordinator owns every file from intake to effective date.
- Enrollment model selection: individual PT, PT group practice or rehab agency
- Medicare enrollment through PECOS with PT specialty designation and group reassignments
- Commercial credentialing directly and through Optum Physical Health, ASH and similar networks
- State Medicaid and MCO enrollment where physical therapy is covered
- CAQH profiles for every therapist with specialties and certifications
- PTA supervision documentation and billing configuration
Physical therapy enrollment by practice model
PT in private practice
Individual Medicare enrollment, or group enrollment with reassignment for multi-therapist practices. See Medicare provider enrollment.
Rehab agency
Facility enrollment with state survey and certification; different billing rules.
Hospital outpatient
Billed under the hospital; therapists need privileges, not separate enrollment. See hospital privileging.
Commercial networks
Optum Physical Health, ASH and plan-specific networks. See chiropractic credentialing for the same network landscape.
Occupational and speech therapy
Similar structure with separate provider types. See occupational therapy credentialing.
How the work runs
- 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.
Frequently asked questions
Medicare 30 to 60 days, commercial plans and physical medicine networks 60 to 150 days. We run everything in parallel and prioritize the plans with the most PT referral volume in your area.
Yes. PTs in private practice enroll directly. A physician plan of care certification is required for Medicare coverage, but the therapist bills under their own NPI.
No. PTAs work under PT supervision and are not enrolled individually, but their services must be billed with the CQ modifier for Medicare and documented per state supervision rules.
UnitedHealthcare uses Optum Physical Health in most markets; several Blue plans and Cigna use ASH or similar networks. Aetna and others credential PTs directly. We confirm the routing for each plan in your area.
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.