Provider credentialing and payer enrollment
Medicare, Medicaid and commercial enrollment handled start to finish, with a weekly status update until the payer decides. Free with every billing plan.
Credentialing delays cost real money. A provider who sees patients before an enrollment is approved may not be able to bill those visits at all, and a lapsed CAQH attestation or missed Medicare revalidation can stop payments that were flowing fine last month. Most of these problems come from incomplete applications and nobody following up with the payer.
SFA Solutions prepares and submits your applications, keeps your CAQH ProView profile current, and follows up with payers on a set schedule until each enrollment is decided and loaded. We handle Medicare enrollment through PECOS (CMS-855I for individuals, CMS-855B for groups), state Medicaid enrollment, commercial credentialing and contracting, NPI and taxonomy updates in NPPES, and recredentialing. We do not quote a number of days for a payer's decision. Medicare, Medicaid, and each health plan run their own queue. SFA prepares the application, files it, follows up every week, and tells you when the payer asks for something else. Credentialing is included free with every billing plan.
Who this is for
Credentialing is most valuable for new practices opening their doors, providers joining or leaving a group, nurse practitioners and PAs enrolling under their own NPI, and groups adding a new location or a new tax ID. Behavioral health, primary care and physical medicine practices often need many payer panels at once, which is where steady follow-up makes the biggest difference.
Related services
Credentialing, enrollment, and contracting
These are three different steps. One approval does not finish the others.
Credentialing is the review of the provider's qualifications: license, training, work history, malpractice, and sanctions. A health plan's credentialing committee decides whether the provider meets that plan's standards.
Enrollment is the record that lets a claim be submitted. For Medicare, that record is in PECOS. For Medicaid, it is the state agency or the managed care plan. A commercial plan also has to load the provider on its payment roster.
Contracting is the participation agreement and the fee schedule. A provider can be credentialed and still be waiting on a contract. A provider can be enrolled in Medicare and still have no commercial contract.
SFA prepares the PECOS application, the state Medicaid application, and the commercial application you choose, and we ask for the fee schedule before you sign. We follow each file until the payer decides and the provider is loaded. We do not promise that a payer will approve the file, open a closed panel, or pay a particular rate.
See the pricing page, a sample credentialing tracker, and security and compliance. Request a free practice review to start.
What our credentialing & payer enrollment service covers
Medicare enrollment
PECOS applications for individual providers and groups, reassignment of benefits to the group, and revalidation when CMS posts your due date.
Medicaid enrollment
State Medicaid and managed Medicaid plan enrollment, following each state's forms, fingerprinting and site visit rules where they apply.
Commercial contracting
Applications to Aetna, Blue Cross Blue Shield plans, Cigna, UnitedHealthcare, Humana and regional plans, plus fee schedule requests before you sign.
CAQH ProView management
Profile setup, document uploads, payer authorizations and re-attestation every 120 days to help keep your profile current with payers.
NPI and taxonomy
Type 1 and Type 2 NPI setup and NPPES updates, with taxonomy codes matched to what each payer has on file.
Recredentialing and tracking
A calendar of license, DEA, malpractice and board certification expirations, and recredentialing filed before deadlines.
How we deliver it
Week 1
We gather licenses, DEA, malpractice, work history and practice details, then audit your CAQH profile and NPPES record for mismatches.
Weeks 1 to 2
Applications go out to Medicare, Medicaid and the commercial payers you choose, prioritized by your patient mix.
Every week
We follow up with each payer by phone and portal, answer development requests quickly, and send you a status sheet.
Approval
We confirm effective dates, verify the provider is loaded correctly in each payer's system, and release held claims for billing.
Week 1 and weeks 1 to 2 are SFA's preparation and filing. They are not the payer's decision date.
What sets the date
| Item | What controls the date | SFA's part |
|---|---|---|
| Medicare, Medicaid, or a commercial application | That payer's own queue, and any request for more information. A commercial panel can be closed. | File a complete application and follow up every week until the payer decides. |
| Medicare effective date | For physicians, non-physician practitioners, and the other types listed in 42 CFR 424.520(d), the later of the filing date of an application the contractor later approves, or the date services began at the new location. | Confirm the effective date before held Medicare claims are released. |
| CAQH re-attestation | CAQH asks for a new attestation every 120 days, or every 180 days for providers practicing in Illinois. A missed date can expire the profile. | Watch the date and complete the attestation with the documents you provide. |
| Medicare revalidation | Providers and suppliers other than DMEPOS suppliers revalidate every 5 years. CMS can also ask off cycle, and CMS posts the due date. Missing it can deactivate billing privileges. | File when CMS posts your due date. |
| Commercial recredentialing | Plans that follow NCQA recredential at least every 36 months. The plan's own notice controls. | Track the date that plan gives us and file before it. |
Credentialing & Payer Enrollment for your specialty
We bill for 28+ specialties. These are the ones we work with most.
Nurse Practitioner billing
Billing for NP-led and physician-NP practices, from the 85% Medicare rate and incident-to rules to split/shared visits and getting each NP credentialed under the right NPI.
Learn moreInternal Medicine billing
Billing for internists who manage complex, chronic patients, with E/M levels, wellness visits and care management codes captured when the documentation supports them.
Learn moreOphthalmology billing
Eye exam codes, refraction, diagnostic testing, cataract globals and high-cost injectable drugs all follow their own rules. Ophthalmology is one of the specialties we bill most often.
Learn moreQuestions about credentialing & payer enrollment
How long does credentialing take?
There is no single number of days. Medicare, each state Medicaid program, and each commercial plan decide their own files. A closed commercial panel can stop an application. SFA's work is the checklist in the first week, filing in the first two weeks, and a weekly status update until the payer decides. Start before the provider sees patients. Filing early does not guarantee that early visits will be paid.
Can we bill for visits before enrollment is approved?
For the provider types in 42 CFR 424.520(d), Medicare's effective date is the later of the day the contractor received an application it later approves, or the day the provider began services at the new location. Under 42 CFR 424.521, some of those providers may bill for services up to 30 days before that effective date, and up to 90 days before it after a presidentially declared disaster, only when they could not enroll first, state licensure and the other Medicare requirements were already met, and the services were at the enrolled location. That lookback is not automatic. Commercial plans set their own rules, and many do not pay for visits before the provider is loaded. We confirm the effective date with the payer before held claims are released.
Is credentialing really free?
Yes, credentialing and recredentialing are included free with every billing plan. Credentialing only is $200 per provider per payer (Free with Billing Services), paid after approval.
What do you need from the provider?
Usually a state license, DEA and state controlled substance registration if applicable, malpractice certificate, board certification, CV with work history, NPI, and CAQH login if a profile exists. We send a checklist on day one.
What if a payer says the panel is closed?
We ask for the denial in writing, check whether the plan has network adequacy gaps for your specialty or location, and request reconsideration where it makes sense. Some practices also join through an existing group contract or an IPA.
Start with a free review
Tell us a little about your practice. We will look at where credentialing & payer enrollment is costing you money today and walk you through what we find.
- No commitment
- Reply from an RCM specialist, typically within one business day
- No patient records needed to start
Get a free review
An RCM specialist typically replies within one business day.