Medical Credentialing & Payer Enrollment
End-to-end CAQH, Medicare (PECOS), Medicaid, and commercial payer credentialing for individual providers, group practices, and facilities — plus recredentialing, revalidation, and hospital privileging support.
Credentialing vs. payer enrollment — why both matter
Credentialing is the payer or facility's process of verifying who you are: your medical education, postgraduate training, active licenses, DEA, board certifications, malpractice coverage, work history, and sanctions history against the OIG LEIE, SAM, and NPDB. Payer enrollment is the contracting step that loads you (or your group) into a payer's system and links your NPI, TIN, and service locations so claims can adjudicate and pay.
Practices that treat these as one step lose weeks. A clean CAQH profile, correctly filed 855s in PECOS, state Medicaid enrollment, and each commercial payer's application all have to line up before a provider can bill in-network. We manage the full workflow and give you a status log per payer.
What we handle
CAQH ProView
Profile setup, document uploads, authorized-payer designations, and 120-day attestation cycles.
Medicare / PECOS
CMS-855I, 855B, 855R reassignment, 855O order/refer, and Medicare revalidation.
Medicaid enrollment
State Medicaid enrollment in every state where the provider or group will render services.
Commercial payers
BCBS plans, UnitedHealthcare, Aetna, Cigna, Humana, Anthem, and regional/behavioral-health carriers.
Recredentialing
Recredentialing every ~3 years (commercial/Medicaid) and Medicare revalidation every 5 years.
Facility & hospital
Group/facility credentialing, hospital privilege applications, and MSO packet preparation.
Documents we'll need from you
- Current state license(s), DEA, and any controlled-substance registrations
- NPI (Type 1 for the provider; Type 2 for the group) and NPPES login
- Medical school diploma and postgraduate training certificates
- Board certification(s), if applicable
- Current malpractice certificate of insurance
- 10-year work history with month/year and gap explanations
- Government-issued photo ID
- Group information: legal name, TIN, W-9, service locations, hours
How our workflow runs
All timelines are controlled by the payers, hospitals, and government programs. We do not guarantee approval or specific effective dates.
Disclosures
PF Consulting Firm is not a law firm and does not provide legal advice. Credentialing decisions and effective dates are made by the payers, government programs, and facilities to which the provider applies. We do not guarantee approval, network participation, reimbursement rates, or timelines.
The provider is responsible for the accuracy of the information submitted and for maintaining current licensure, DEA, malpractice coverage, and CAQH attestations after enrollment.
Get providers in-network without the back-and-forth
One team for CAQH, Medicare, Medicaid, and every commercial payer on your target list.
Credentialing FAQ
What is medical credentialing?
Credentialing is the process by which health plans, hospitals, and facilities verify a provider's education, training, licensure, work history, malpractice coverage, and sanctions status. Payer enrollment is the related process of getting the provider (or group) contracted and loaded with a specific payer so claims can be paid. Most practices need both.
How long does credentialing take?
Timing is set by the payers, not by us. Medicare enrollment through PECOS commonly runs 60 to 90+ days once a clean 855 is submitted. Medicaid varies by state — often 60 to 120 days. Commercial payers (BCBS plans, UnitedHealthcare, Aetna, Cigna, Humana, and others) typically run 60 to 120 days from submission with primary-source verification and committee review. We do not guarantee timelines.
What is CAQH ProView and do I need it?
CAQH ProView is a centralized provider data repository used by most commercial payers and many Medicaid programs. Providers maintain a single profile that participating payers query during credentialing and recredentialing. Setting up CAQH correctly — with signed authorizations, current documents, and attestation every 120 days — is a prerequisite for most commercial credentialing.
What is the difference between individual and group enrollment?
Individual enrollment ties the provider's NPI (Type 1) and credentials to a payer. Group enrollment ties the group entity's NPI (Type 2), TIN, W-9, and locations to the payer. In most cases the individual provider is 'reassigned' to the group so payments flow to the group's TIN. We handle both sides and the reassignment (Medicare CMS-855R equivalents where applicable).
Do you handle Medicare (PECOS) enrollment?
Yes. We prepare and submit CMS-855I (individual practitioners), 855B (organizations), 855R (reassignment), 855O (order/refer only), and revalidations through PECOS. We also manage NPPES NPI applications and updates.
Do you handle recredentialing?
Yes. We track recredentialing cycles — typically every three years for commercial payers and Medicaid, and every five years for Medicare revalidation — and manage the updated attestations, CAQH refreshes, and payer-specific paperwork.
Do you support hospital privileges and facility credentialing?
Yes. We assist with hospital privilege applications, medical staff office (MSO) packets, ambulatory surgery center credentialing, and facility-level credentialing for clinics, DME, home health, hospice, and behavioral health. Final privileging decisions rest with the facility's medical staff and governing body.
Do you serve all 50 states?
Yes for CAQH and commercial payer credentialing. Medicaid is state-specific — we work Medicaid in every state where our client is enrolling, subject to that state's rules.