Credentialing is where practices quietly lose money. If you are not in network the claim still goes out, still gets worked, and still does not get paid. One application can take three to six months when nobody is chasing it, and a single blank field sends it back to the start.
This is what we do best. Our medical credentialing services own the file from the first form to the approval letter, and we push the payer every week rather than waiting for a letter that may never come.
Credentialing by provider type
Credentialing is not one process. What a payer asks a dentist for has almost nothing in common with what it asks a behaviour analyst, and the network that credentials a physical therapist is often not the health plan at all. Start with your provider type:
- Therapist & mental health credentialingLPC, LCSW, LMFT, psychologists and PMHNPs. Behavioral carve-outs, closed panels and the 2024 Medicare change.
- Dental credentialing servicesDelta Dental, MetLife, Cigna, Aetna and United Concordia. Associate linking and fee schedule review.
- Nurse practitioner credentialing servicesNPs and PAs. PCP panel requests, collaborative agreements and the Medicare 85% rule.
- Physical therapy credentialing servicesPT, OT and speech. Medicare private practice enrollment and the ASH and Optum networks.
- ABA credentialing servicesBCBAs, BCaBAs and RBTs. Agency enrollment, state Medicaid programs and roster management.
- Chiropractic credentialing servicesMedicare manual manipulation rules, ASH and Optum, plus workers comp panels.
- Telehealth credentialing servicesMulti-state licensing, the compacts, and payer enrollment state by state.
- Physicians and surgical specialtiesHospital privileges, ASC enrollment and group contracting. Tell us your specialty and we will scope it.
What is included
- CAQH profile built, attested and kept current on the CAQH ProView portal, including the 120-day re-attestation.
- Medicare and Medicaid enrollment through PECOS, including revalidation.
- Commercial panel applications with the plans your patients carry, filed to the correct network or carve-out.
- NPI and NPPES registration for new providers, new groups and new locations.
- Re-credentialing tracked and filed to NCQA standards before your dates expire.
- Contract and fee schedule review before you sign.
- Weekly status reports so you always know where each file stands.
How long credentialing takes
| Payer type | Typical time to effective date | What slows it down |
|---|---|---|
| Medicare | 45 to 90 days | PECOS validation, reassignment filed separately |
| State Medicaid | 60 to 120 days | State backlogs; each managed care plan enrolls separately afterwards |
| Commercial, direct | 90 to 120 days | Committee meeting dates and primary source verification |
| Delegated network or carve-out | 60 to 120 days | Application sent to the plan rather than the network that owns it |
| Adding a provider to an existing group | 30 to 60 days | Filing a full application when a linking form was required |
Two things cause most avoidable delay: a CAQH attestation that lapsed mid-application, and a gap in the work history that nobody explained. We remove both before the file goes out.
Payer credentialing guides
How each major payer's credentialing actually works, who owns the network, what the timeline really is, and what causes the delays. Written for providers, not for search engines.
- BCBS credentialingWhy each state plan is a separate application, what BlueCard means, and who owns the behavioral network.
- UnitedHealthcare & OptumWhen Optum credentials you instead of UHC behavioral health and physical health networks.
- Medicare enrollment (PECOS)CMS-855 forms, reassignment, retrospective billing and the revalidation that stops payments.
- Aetna credentialingCAQH-driven, in-house behavioral health, and the network need review that comes first.
- Cigna & EvernorthMedical goes to Cigna, behavioral goes to Evernorth. Applications to the wrong one are not forwarded.
- Medicaid enrollmentThe state program first, then every managed care plan separately, including the Virginia process.
- Delta Dental credentialingMember companies, the PPO and Premier tier decision, and associate linking.
- Choosing a credentialing serviceAn honest comparison of the options for therapists, including when not to hire anyone.
Credentialing and billing together
Most companies do one or the other, so your panels and your claims fall out of step and you end up billing a payer you are not yet in network with. Here the same team owns both, and the first clean claim goes out the week your effective date lands.
- Revenue cyclemedical billing services claim submission, denial work and aged AR recovery.
- By specialtybilling services by specialty 50+ specialties, each with its own coding rules.
Medical credentialing FAQs
How long does medical credentialing take?
Most payers take three to six months from a complete application to an effective date. With CureCloudMed the usual range is one to three months, counted from the day we have a complete file. The delay is rarely the payer itself. It is a missing document, an old CAQH attestation, or nobody following up. We keep the file complete and chase it weekly.
What is CAQH and why does it matter?
CAQH ProView is the shared profile most commercial payers pull your credentials from instead of reading each application from scratch. It has to be complete and re-attested every 120 days. A lapsed attestation stalls every application you have in flight, silently.
How much does credentialing cost?
It is quoted per provider, per payer, because that is how the work scales. Bundled with billing the credentialing rate drops. You get the quote in writing before any work starts.
Can I bill while my application is pending?
Not as in-network. Some payers backdate to the application date and some do not, and that difference can be worth thousands. We ask for a backdate in writing on every application.
What is the difference between credentialing and contracting?
Credentialing is the payer verifying who you are. Contracting is signing the participating provider agreement and its fee schedule. You can pass the first and still not be in network because nobody countersigned the second, which is why we chase the executed contract rather than the approval letter.
Do you handle re-credentialing?
Yes, and we track the dates rather than reacting to them. Re-credentialing is usually a three-year cycle, and it is also triggered by a new location, a new tax ID, an ownership change or a change of practice name.
Free credentialing check
Tell us your provider type, your state and the plans your patients carry. We will tell you which panels are open, which are worth the paperwork, and how long each one should take.
Free credentialing check Talk to a credentialing specialist