Work history and gap explanations
Payers verify every position and require explanations for gaps. Residency and fellowship dates that do not line up with the CV send the application to development.
Provider credentialing
Physician Credentialing Services
Physicians carry the most credentialing weight of any provider type: board certification, hospital privileges, DEA, malpractice history and a work history payers scrutinize line by line. We prepare the file once and use it for every payer and every facility.
- Full file built to NCQA standards
- Medicare, Medicaid, commercial in parallel
- Hospital privileges coordinated
- Typical full timeline: 4 to 5 months
- One coordinator per physician
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
A physician joining a practice or opening one needs Medicare enrollment, Medicaid enrollment in the practice state, credentialing with every commercial panel that matters, and often hospital privileges that payers ask about. Each process asks for the same underlying documents in a slightly different form, and each has its own timeline that runs 60 to 180 days.
ClainetRCM manages all of it in parallel. One coordinator owns the physician's file, assembles it to NCQA standards, and drives every application to an effective date. For groups, we do the same for each physician on the roster and keep the roster synchronized.
Where this usually goes wrong
Board certification status
Board eligible is not board certified. Some payers close panels to non-certified physicians in certain specialties, and certification lapses trigger re-credentialing problems.
Malpractice history disclosures
Any settlement or claim must be disclosed and explained. Payers verify against the NPDB, and undisclosed history is grounds for denial.
What ClainetRCM handles for you
One coordinator owns every file from intake to effective date.
- Complete physician file assembled to NCQA standards, including CV, board and training verification
- Medicare enrollment and reassignment through PECOS
- State Medicaid and managed care enrollment
- CAQH ProView profile setup and attestation
- Commercial payer applications with every prioritized plan, filed in parallel
- Hospital privileges applications and payer follow-up through effective date
Physician credentialing by specialty
Cardiology
Device and procedure privileges, high Medicare Advantage exposure. See cardiology credentialing.
Orthopedics
Surgical privileges and ASC credentialing. See orthopedic credentialing.
Dermatology
Panel closures in saturated markets. See dermatology credentialing.
Pediatrics
Medicaid and CHIP heavy payer mix. See pediatric credentialing.
OB/GYN
Hospital privileges and malpractice scrutiny. See OB/GYN credentialing.
Pain management
DEA, CDS and procedure privileges. See pain management credentialing.
The core file is the same for every physician; what changes is which payers matter and which privileges are needed. Specialty pages with the details:
All 52 specialties we support are listed on our specialties page.
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 typically 30 to 60 days, commercial payers 90 to 150 days, hospital privileges 90 to 180 days. Running them at the same time means a physician with a complete file is usually fully payable within four to five months.
Many payers ask for admitting privileges or a documented admitting arrangement in specialties that admit patients. Office-based physicians can usually satisfy this with a coverage agreement. See hospital privileging.
Most payers accept board eligibility within a defined window after training, typically a few years. We document eligibility status and track the certification deadline so it does not become a re-credentialing problem.
Yes. The new state license comes first through our provider licensing service, then Medicare location updates, state Medicaid and commercial payers in the new state.
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.