Nationwide Payor Credentialing & Payer Enrollment Services

What Is Payor Credentialing?

Payor credentialing — also written as payer credentialing — is the formal process by which health insurance companies verify a healthcare provider's education, training, licensure, board certifications, malpractice history, and professional standing before authorizing that provider to join their network. Without completed credentialing, a provider cannot bill that insurance company for services rendered to insured patients. The average credentialing process takes 60–120 days for commercial payers and 45–90 days for Medicare PECOS enrollment.

Payor credentialing is distinct from payer enrollment: credentialing is the verification of qualifications, while enrollment is the contracting step that follows — where the provider signs a participation agreement and receives an effective billing date. ProEnrollment LLC manages both steps end-to-end.

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 — documentation errors and CAQH profile mismatches — getting your practice in-network 40% faster than the industry average.

How Does the Credentialing Process Work?

1. Step 1: Gather & Audit Provider Credentials — Collect state license, DEA, NPI, malpractice insurance, board certs, and employment history. ProEnrollment audits every document before submission.
2. Step 2: CAQH ProView Setup & Maintenance — Build or audit your CAQH ProView profile. CAQH is queried by 1,000+ health plans and must be attested every 120 days.
3. Step 3: Payer-Specific Application Packages — Each payer has unique requirements. ProEnrollment prepares customized packages for every target payer simultaneously.
4. Step 4: Submit to All Payers Simultaneously — Medicare PECOS, all Medicaid programs, and all commercial payers in the same submission wave.
5. Step 5: Proactive Follow-Up Every 7–10 Business Days — We push stalled applications before they age. Deficiency responses within 24 hours.
6. Step 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 — Aetna, UHC, BCBS, Cigna, Humana and 50+ commercial plans
• Medicare PECOS Enrollment — CMS-855I, 855B, 855R applications, PTAN assignment, revalidation
• Medicaid Enrollment — All 50 state Medicaid programs and MCO participation
• CAQH ProView Setup & Management — Initial setup, quarterly attestation, document maintenance
• Insurance Contract Negotiation — Fee schedule benchmarking and rate optimization (+22% avg. lift)
• Re-credentialing & Revalidation — Proactive cycle tracking and Medicare revalidation management
• New Practice Setup Credentialing — Entity NPI, TIN, CAQH, and multi-payer enrollment from Day One
• Behavioral Health Credentialing — LCSW, LPC, LMFT, psychologist, and psychiatrist panel enrollment

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

With over 9 years of experience and a 99.4% success rate, ProEnrollment LLC is the trusted choice for physicians, group practices, and healthcare organizations. We offer nationwide expertise with a Dallas, TX base, direct payer communication, HIPAA-compliant data management, and strategic rate negotiations that lift reimbursements by an average of 22%.

• 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 data management — BAA executed with every client
• Dedicated specialist assigned to every account
• Work begins within 48 hours of engagement

Contact ProEnrollment LLC