Provider Credentialing & Enrollment Services

Flagship Service Service 01

Hospital & Clinical Privileging.

This is where Provider Privileging started. It's where we go deepest.

We credential healthcare practitioners for hospital and clinical privileges — the rigorous process by which a facility grants a provider authority to practice within that institution and perform specific clinical services. From initial appointment through reappointment, we handle the documentation, coordinate with medical staff offices, and track every deadline so privileges never lapse.

Initial appointment applications and complete documentation packages
Reappointment and re-privileging cycle management
Delineation of clinical privileges review and preparation
Medical staff office liaison and follow-up
Temporary, emergency, and locum tenens privilege coordination
Telemedicine and telehealth privileging support
Privilege status tracking and expiration monitoring in your portal

Start a Privileging Application

Clinical Privileges

Hospital & Facility Appointments

✓Initial Appointment — Approved

✓Privileges Delineated

✓Medical Staff Office — Confirmed

→Reappointment — Scheduled

Service 02

Provider Credentialing.

The foundation of every enrollment.

Primary source verification of every license, every DEA, every board certification, every malpractice COI. Sanctions screening across OIG, SAM, NPDB, and state exclusion lists. Credential file maintenance that meets NCQA and Joint Commission standards. Whether it's an initial credentialing application or a re-credentialing cycle, we manage it end to end.

Primary source verification (PSV) of all licenses, DEA, certifications, and training
Board certification tracking and expiration monitoring
Malpractice history and Certificate of Insurance (COI) management
Sanctions screening — OIG, SAM, NPDB, and state-level checks
Education, training, and work history verification
Re-credentialing cycle management
Practitioner data collection via our secure online onboarding portal
Audit-ready documentation, always

Start Credentialing

Credentials Verified

PSV · Licenses · DEA · Board Certs · COI · Sanctions

Active License ✓ DEA Current ✓ Board Certified ✓ COI Uploaded ✓ OIG Clear ✓

Service 03

Payer Enrollment.

Medicare PECOS · Medicaid · all major commercial payers · network contracting — under one roof.

Submitting applications to insurance companies to get your providers and facilities recognized as in-network. We enroll medical, behavioral health, and dental providers across every major payer, handle both individual and facility/organizational enrollments, and manage the full PECOS-and-Medicaid-and-commercial pipeline from application through approval. We also handle the contracting work that ensures the in-network designation reflects your organization's terms.

Medicare & PECOS — surrogacy setup, application submission, reassignment of benefits, PTAN tracking, Railroad Medicare
Medicaid affiliation — NM Medicaid and other states, multi-location and multi-facility setups, RHC enrollment
Commercial payers — BCBS, Presbyterian, United, Humana, Molina, CIGNA, Tricare, MultiPlan, and more
Network contracting — delegated agreement review, in-network status confirmation, effective dates, location additions, gap identification
Individual provider and facility/organizational enrollment
Status tracking and active payer follow-up — we chase stalled apps
Re-enrollment for practice location, NPI, or specialty changes
Working directly with your providers to collect needed information

Enroll Your Providers

Active Payer Enrollments

Sample roster, anonymized

MedicareEnrolled ✓

NM MedicaidEnrolled ✓

BCBS New MexicoIn Progress…

Presbyterian HealthplanSubmitted

United HealthcareEnrolled ✓

MultiPlanFollowing Up

Service 04

CAQH Profile Management.

The layer most commercial payers depend on — never overdue, never a bottleneck.

CAQH ProView is the universal provider data repository used by most commercial payers. A complete, accurate, and re-attested profile is required before most payer enrollments can move forward. We set up new profiles, complete every section, upload every document, and re-attest on schedule — at 60 days, not 180 — so a CAQH lapse never delays a single application.

Account setup and initial profile completion
Document upload — license, DEA, COI, board certifications
60-day re-attestation cycles (we don't wait for the 180-day reminder)
Profile updates for new specialties, locations, or employers
CAQH credential verification for delegated payers

Manage My CAQH

CAQH Profile Status

Last re-attested: on schedule

100%

Profile Complete

All documents current · All sections filled

Service 05

Ongoing Maintenance & Roster.

The work between the work — handled automatically, visible in your portal, never falling through the cracks.

Credentialing isn't a moment. It's a cycle. Licenses expire, certifications lapse, payers require re-attestation, directories need updating, sanctions lists shift. A single missed deadline can pull a provider out of network and disrupt your revenue cycle. We continuously monitor every credential and compliance signal across your roster — so nothing slips. You just see it completed in your portal.

License, DEA, COI, and board certification expiration monitoring and alerts
CAQH 60-day update cycles managed automatically
Ongoing sanctions monitoring — OIG, SAM, NPDB, state exclusion lists
Directory attestations for the commercial payers that require them
Re-credentialing windows flagged before payers ever notice
120-day reappointment notices managed before medical staff offices send warnings
Roster changes — additions, removals, location updates, specialty changes
Compliance reporting for NCQA and Joint Commission audits
Stalled payer application follow-ups (we chase past 60, 90, 120 days — most firms wait)

Keep Your Roster Compliant

Compliance Dashboard

All credentials monitored continuously

LicensesCurrent ✓

OIG / SAM / NPDBClear ✓

CAQH Re-AttestationsOn Schedule ✓

Directory AttestationsUp to Date ✓

Malpractice COIRenews in 45 days

Re-credentialing (next 90d)13 flagged

Common Questions

Answers to what you're already wondering.

The questions billing managers, practice administrators, credentialing directors, and providers ask us most.

How long does provider credentialing take? +

Credentialing timelines vary by payer, but most commercial payer enrollments take 60–120 days. Medicare PECOS enrollment can take 60–90 days. We begin submitting applications as soon as your onboarding is complete, and we track and follow up on every application to minimize delays.

What's the difference between credentialing, privileging, and enrollment? +

Credentialing is verifying a provider's qualifications (licenses, education, board certifications). Privileging is a facility granting a provider authority to practice and perform specific clinical services. Enrollment is the process of getting a provider recognized and contracted with an insurance payer so they can bill for services. We handle all three.

Do we need to do anything, or do you handle everything? +

We do all the work — but we need two things upfront: your organization's enrollment directives (which payers, locations, and NPIs to use) and the practitioner's personal credentials and documents. Both are collected through our secure online portal, and after that, we take it from there.

Can we track the status of our enrollments? +

Yes. Every client gets access to our secure online credentialing portal where you can see real-time enrollment statuses, provider demographics, and document records — anytime, from anywhere.

What types of providers do you credential and enroll? +

We credential and enroll physicians (MD/DO), nurse practitioners (NP/APRN), physician assistants (PA), licensed clinical social workers (LCSW), licensed professional counselors (LPC), psychologists, psychiatrists, CRNAs, dentists, dental hygienists, and other allied health professionals. We also handle facility and organizational payer enrollments. If it needs to be credentialed or enrolled with a payer, we can handle it.

Do you work with new practices that are just starting out? +

Absolutely. We help new medical, behavioral health, and dental practices from the ground up — NPI registration, CAQH profile creation, initial payer enrollment applications, Medicare and Medicaid setup. We'll get your practice billing-ready.

What payers do you work with? +

We work with Medicare, Medicaid (including NM Medicaid), BCBS, Presbyterian, United Healthcare, Humana, Molina, CIGNA, Health Net/Tricare, Railroad Medicare, and other commercial payers. If your organization contracts with a payer, we can enroll your providers with them.