Nationwide Payor Credentialing & Payer Enrollment Services

What Is Payor Credentialing?

Payor credentialing is the formal process by which health insurance companies verify a healthcare provider's qualifications — education, licensure, board certifications, malpractice history, and professional standing — before authorizing that provider to join their network. Without completed credentialing, a provider cannot bill that payer for services rendered to insured patients.

Commercial payer credentialing typically takes 60–120 days. Medicare PECOS enrollment takes 45–90 days. Credentialing is the verification step; payer enrollment is the contracting step that follows. ProEnrollment LLC manages both processes end-to-end for physicians, group practices, and healthcare organizations nationwide.

Expert Payor Credentialing Services for Physicians & Clinics

Delayed credentialing costs the average physician practice $10,000–$30,000 per month in lost revenue. ProEnrollment LLC's pre-submission data audit eliminates the #1 cause of delays — CAQH profile mismatches and documentation errors — getting your practice in-network 40% faster than the industry average.

We don't compete on price — we compete on measurable outcomes. Our 99.4% application approval rate across all payer types reflects a process built on precision, not speed for its own sake.

How Does the Credentialing Process Work?

1. Gather & Audit Provider Credentials — State license, DEA, NPI, malpractice insurance, board certifications, and employment history. ProEnrollment audits every document before submission.
2. CAQH ProView Setup & Maintenance — Build or audit your CAQH ProView profile. Queried by 1,000+ health plans; must be attested every 120 days.
3. Payer-Specific Application Packages — Customized credentialing packages for every target payer submitted simultaneously.
4. Submit to All Payers Simultaneously — Medicare PECOS, all Medicaid programs, and all commercial payers in one submission wave.
5. Proactive Follow-Up Every 7–10 Business Days — We push stalled applications before they age; deficiency responses within 24 hours.
6. Effective Date Confirmation & Billing Activation — Written effective date confirmation before billing begins; retroactive date documentation where applicable.

Our Credentialing & Enrollment Services

• Payor Credentialing Services — Commercial payer credentialing with Aetna, UHC, BCBS, Cigna, Humana, and 50+ plans.
• Medicare PECOS Enrollment — CMS-855I/855B/855R applications, PTAN assignment, and revalidation management.
• Medicaid Enrollment — All 50 state Medicaid programs and managed care organizations.
• CAQH ProView Setup & Management — Initial setup, quarterly attestation, and ongoing document maintenance.
• Insurance Contract Negotiation — Fee schedule benchmarking and rate negotiation; average 22% reimbursement increase.
• Re-credentialing & Revalidation — Proactive cycle tracking to prevent billing interruptions.
• New Practice Setup Credentialing — Full setup from entity NPI through first in-network date.
• Behavioral Health Credentialing — LCSWs, LPCs, LMFTs, psychologists, and psychiatrists.

Credentialing by Medical Specialty

• Psychiatry Credentialing
• Mental Health Credentialing (LPC, LCSW, MFT)
• Primary Care Credentialing
• Cardiology Credentialing
• Physical Therapy Credentialing
• Dermatology Credentialing
• Chiropractic Credentialing
• Pediatrics Credentialing
• Telehealth Credentialing
• Nurse Practitioner & PA Credentialing
• OB/GYN Credentialing
• Surgery Credentialing
• Urgent Care Credentialing
• Dental Credentialing

Why Choose ProEnrollment LLC

• 99.4% application approval rate across all payer types
• 40% faster average credentialing than industry standard
• 500+ providers enrolled across all 50 states
• HIPAA-compliant — BAA executed with every client
• Dedicated specialist assigned to every account
• Work begins within 48 hours of engagement

Frequently Asked Questions

How long does payor credentialing take?

Commercial payer credentialing typically takes 60–120 days. Medicare PECOS enrollment takes 45–90 days. ProEnrollment gets providers credentialed 40% faster through pre-submission auditing and simultaneous multi-payer submission.

What is CAQH ProView and do I need it?

CAQH ProView is a centralized database used by 1,000+ health plans to verify provider credentials. Most commercial payers require an active CAQH profile before processing applications. ProEnrollment handles full setup, quarterly attestation, and ongoing maintenance.

What payers does ProEnrollment work with?

All major commercial payers — Aetna, UnitedHealthcare, BCBS, Cigna, Humana, and 50+ regional plans — plus Medicare PECOS and all 50 state Medicaid programs.

How much does payor credentialing cost?

Pricing is based on provider count and payer mix. Contact us for a free consultation and custom quote tailored to your practice.

Can ProEnrollment credential providers in all 50 states?

Yes. ProEnrollment handles multi-state licensing and payer enrollment in all 50 states, including all state Medicaid programs and multi-state commercial payer contracts.

Contact ProEnrollment LLC