Medical Credentialing Services
Credentialing is the gate between a provider and getting paid. Until a payer has verified the license, confirmed the NPI and approved the enrollment, every claim that provider sends comes back denied. One missing form on a CMS 855 application can stall revenue for months.
So here is the short version. Medical credentialing is the process of verifying a healthcare provider's qualifications and enrolling that provider with insurance payers, so they can treat patients in network and bill for it. ProCred runs that process end to end for physicians, groups and facilities across the United States.
Built on the standards payers actually check against
We do not ask you to take our word for it. We work to the same standards the payers and accreditors use, so applications go in clean the first time.
What medical credentialing services include
Credentialing is not one task. It is a stack of verifications and applications, and each one has to be right. Here is what we handle:
How our credentialing process works
You hand off the paperwork. We run a clear, trackable process and tell you exactly where each application stands.
Credentialing vs payer enrollment: the difference
These two terms get used as if they mean the same thing. They do not, and the distinction matters for your timeline.
You almost always need both, in that order, for every payer. We handle credentialing and enrollment together so there is no gap between them.
Our credentialing services
Pick the service you need:
Specialties we serve
Credentialing rules and payer panels shift by provider type. We run dedicated workflows for each:
Who we credential
We credential and enroll providers of nearly every type: physicians and surgeons, nurse practitioners and physician assistants, behavioral and mental health providers, dentists and dental groups, telehealth groups operating across state lines, DME suppliers, and new or multi provider group practices. New to all of this? Start with what is medical credentialing or browse our resources.
Credentialing in all 50 states
We are a national service. We credential and enroll providers in every US state, which means we know how each state Medicaid program and licensing board works, not just the easy ones.
State Medicaid portals, supervision rules and timelines vary, so local knowledge saves weeks. See all locations, or jump to a high volume state: Texas, California, Florida or New York.
Payers we handle
We enroll providers with the payers that actually move your revenue:
Once you are live, we set up EDI, ERA and EFT, so claims, remittances and payments all flow electronically from day one. More on that on the payer enrollment page.
How long credentialing takes
Timelines depend on the payer, not on how fast you fill out the forms. These are industry typical ranges, not a guarantee:
CAQH attestation has to be refreshed every 120 days to stay current, and most payers want recredentialing every two to three years. We track those dates so nothing lapses. Any timeline we commit to for your engagement, we put in writing company specific turnaround commitment.
What credentialing late actually costs
Here is the part most practices underestimate. A provider cannot bill a payer before their effective date. If credentialing takes a typical 90 to 120 day window for a commercial plan and you start late, that is three to four months of patient visits you either cannot bill or have to write off.
For a single full time provider, that lost billing window is rarely small, and it compounds across every payer you are not yet enrolled with. Starting credentialing the moment you hire, not the week the provider arrives, is the single cheapest way to protect revenue. We build the schedule backward from your start date so the effective dates land on time.
Transparent pricing
Credentialing pricing in this industry is usually quoted per provider, per payer, or as a flat monthly fee for ongoing maintenance. What drives the number is simple: how many providers, how many payers, and whether you need a one time setup or continuous recredentialing.
We quote each engagement individually rather than hide a number behind a form. Outsourcing also tends to cost less than carrying a full time credentialing coordinator, with no gap when that person is out. See how the math works on our credentialing services cost page. exact pricing is quoted per engagement.
Compliance and data security
Credentialing runs on sensitive provider data, so how it is handled matters. We work to a HIPAA compliant process across every document and portal. Verification follows primary source standards and the NCQA aligned timelines that payer committees expect, and we run OIG and exclusion screening so a sanctioned provider never reaches an enrollment. It is the same rigor an in house compliance team would apply, without the overhead.
Why providers choose ProCred
We are credentialing specialists, not a billing company that does credentialing on the side. We know which form goes to which payer, why an application gets kicked back, and how to follow up without losing an afternoon on hold.
You get one point of contact, status you can actually see, and a team that does this every day. We win on transparency and accuracy: real timelines framed honestly, named payers and forms, and a process you can track, not invented bragging numbers. specific proof points — providers credentialed, years in business, client results.