How to Choose a Credentialing Company: 8 Criteria That Actually Matter

Why This Decision Matters

A provider idle during credentialing costs a practice $10,000–$30,000 per month. Most practices discover a credentialing company is underperforming 60–90 days in. Use this framework to evaluate before you sign.

8 Criteria for Evaluating a Credentialing Company

1. Specialization in payer enrollment — not a billing add-on. Ask: What percentage of the company’s work is credentialing vs billing?
2. Named specialist, not a rotating queue — continuity matters. Ask: Who is my specific point of contact?
3. Pre-submission completeness audit — incomplete applications are the top delay cause. Ask: Walk me through your pre-submission review.
4. Documented payer follow-up — weekly contact with Provider Relations after submission. Ask: How often do you contact payers after submission?
5. Transparent status reporting — you should never have to ask. Ask: How and how often do I receive status updates?
6. Deficiency handling included — not billed separately. Ask: Is your response to a payer ADR included in my fee?
7. Specialty and payer-specific experience — requirements vary. Ask: How many applications have you submitted to [payer] for [specialty] in the past year?
8. Clear flat-fee pricing — know what is and is not included. Ask: What exactly is in your fee, and what costs extra?

Red Flags

• Guaranteed approval timelines not tied to specific payers
• No named point of contact before signing
• Extra charges for deficiency responses or resubmissions
• Status updates only when you initiate contact
• Inability to explain CAQH attestation requirements

How ProEnrollment LLC Addresses Each Criterion

Healthcare provider credentialing and payer enrollment is ProEnrollment’s entire business. Every engagement includes a dedicated account specialist, a 12-point pre-submission audit, payer follow-up every 7–10 business days, written status updates, and deficiency responses included in the fee. See Why ProEnrollment, pricing, or request a free assessment. Also see: Best Credentialing Companies Compared | How Long Does Credentialing Take?