Credentialing Services

Commercial applications: $150

Government applications: $300

Credentialing isn’t just about getting enrolled with insurance companies—it’s about setting things up correctly from the start to avoid major headaches down the road. Too often, providers rush through the process only to realize later that they were set up under the wrong entity, had payments going to a different place, used a home/billing address as their service location, or had errors in their directory listing that made it harder for patients to find them. These small mistakes can snowball into ongoing problems, forcing you to constantly apply temporary fixes just to keep claims going out and (hopefully) getting paid.

We focus on getting credentialing right the first time so you don’t have to deal with these issues. Our goal is to set you up with a strong foundation—one that allows your practice to grow and adapt without unnecessary complications.

How We Approach Credentialing

If you're a new practice or clinician, we start by securing your Medicare and Medicaid contracts. This step is key because it opens the door to enrolling in all commercial Medicaid and Medicare Advantage plans (like Humana Medicare, UHC Medicare, etc.). By handling this first, you ensure that when you credential with a commercial payer, you automatically gain access to all of their plans—public and private.

For example, if you’re credentialed with Medicare, Medicaid, and Humana, you don’t need to check a long list of Humana’s different plans when a patient asks if you take their insurance. You can simply say, “Yes, I take Humana,” because you’re covered for all of their plans.

Group Contracts for Flexibility

We also create a group contract for your practice rather than credentialing you as an individual provider. This gives you much more flexibility if you decide to add or remove clinicians, change locations, or negotiate group reimbursement rates in the future. Many practices don’t realize this upfront and end up credentialing each provider individually, which can make future changes much more complicated than they need to be.

Credentialing Support For Seasoned Professionals

For established practices, whether you're dealing with credentialing issues or simply want to ensure everything stays in order, we can help. Many providers come to us after encountering claim denials, missing or incorrect payer enrollments, outdated directory information, or payment delays caused by credentialing errors. These issues can create ongoing administrative burdens and disrupt cash flow. We work to identify and correct credentialing problems, ensuring that your contracts are properly structured to prevent future disruptions.

Even if your credentialing is in good shape, maintaining it is just as important. Payers frequently update their policies, and a small oversight—like a missed recredentialing deadline or an outdated tax ID—can cause unnecessary complications. We help keep your contracts active, provider details accurate, and credentialing structured in a way that supports your practice’s long-term stability. Whether you need to fix existing problems or want to ensure everything continues running smoothly, we provide the expertise to keep your credentialing secure and hassle-free.

Think Long-Term

The goal is to set up your credentialing in a way that works for you now and in the future. A little extra effort upfront saves a lot of time and frustration later. No one knows exactly how their practice will evolve, but with the right foundation, you’ll have the flexibility to grow without unnecessary roadblocks.

  • Credentialing is the process of verifying your qualifications, licenses, and practice details to ensure you meet an insurance company’s requirements. It also includes contracting (establishing an agreement with the payer) and enrollment (getting added to their system to bill for services). Without proper credentialing, you won’t be able to accept insurance or get reimbursed for claims.

  • Issues may not be immediately obvious but can cause major headaches later when you try to make changes or expand your practice. In some cases, errors can lead to immediate claim denials, requiring back-and-forth with the insurance company to identify and fix the problem. This can delay your ability to see insurance clients for months while also disrupting cash flow, leaving your practice stuck in limbo until the issue is resolved.

  • You don’t necessarily need one, but having a group contract will make things much easier down the road. Adding clinicians is simple—they can be credentialed under your existing contract rather than going through the process individually. If you need to update your practice’s address or other details, you only have to make one change for the entire group instead of multiple changes for each provider. This keeps consistency across your entire practice, preventing discrepancies that can lead to admin issues.

  • It’s not the end of the world by any means, but it does mean that when you apply for contracts with commercial payers like BCBS, Humana, Aetna, or Cigna, you'll be limited to their private plans. You won’t be able to participate in their government-subsidized plans unless you're first contracted with original Medicare and Medicaid.

  • Government insurance applications are more complex and time-consuming than commercial ones. Medicare and Medicaid have stricter requirements, additional documentation, and longer approval timelines. They require multiple extra steps, all of which add to the workload.

  • Medicaid MCOs are private insurance companies that work with the state government to manage Medicaid benefits (like Aetna Medicaid).

    Medicare Advantage plans, similarly, are private alternatives to traditional Medicare (ex. Humana Medicare).

    To see patients with either of these plans, providers must credential with the specific insurance companies offering them, in addition to original Medicare/Medicaid.

Commonly Asked Questions