Provider Credentialing Services
Payer enrollment, CAQH, re-credentialing and persistent follow-up for a flat $250 per payer application, with every payer timeline sourced to the payer.
ClaimCarePro provides provider credentialing services — payer enrollment, CAQH setup and attestation, re-credentialing and persistent follow-up — for a flat $250 per payer application. Every fee is published on this page, from the $1,750 new-practice bundle to $99 per provider per year for maintenance, and the work is done from Clearwater, FL by a team with 30+ years of combined billing and credentialing experience.
Provider credentialing is the process a health plan uses to verify a clinician’s license, education, training, board status, malpractice history and work history before admitting that clinician to its network. It is one of four separate steps between a new provider and a paid claim (credentialing, enrollment, contracting and privileging), and each runs on its own clock.
Every week a provider waits is a week of visits that cannot be billed to that payer. Whether you are onboarding a new physician, opening a location, adding a therapist to behavioral panels or joining new networks, the job is the same: a complete file the first time, follow-up until each payer moves, and an effective date in writing.
Last updated October 8, 2026. Reviewed by Jacob Greenberg, founder, ClaimCarePro. Payer timelines and re-credentialing cadences are checked against each payer’s or regulator’s own published document, linked below.
What our provider credentialing services include
- CAQH setup and attestation: profile built or cleaned up, documents uploaded, each payer authorized, re-attestation calendared.
- Payer enrollment: commercial plans, Medicare through PECOS and Medicaid, one complete application per payer, per provider.
- Persistent follow-up, logged: representative, date, reference number and status recorded for every payer until it moves.
- Effective dates in writing: new-provider claims held and released the day enrollment is confirmed, not on a verbal “approved.”
- Re-credentialing and revalidation: payer cycles, Medicare revalidation, CAQH re-attestation and expiring licenses tracked so no one drops out of network.
- Billing from the same team: pair credentialing with our medical billing services or full RCM services, and we sign a BAA.
Credentialing vs. enrollment vs. contracting vs. privileging
Four words people use as one. They are four steps, run by different people, and each ends with a different result.
| Term | What it is | Who does it | What you have when it ends |
|---|---|---|---|
| Credentialing | The payer (or hospital) verifies the provider is who they say they are and is qualified: license, education, training, board status, malpractice history, sanctions and work history. | The payer’s credentialing team and committee, from documents and the CAQH profile the provider supplies. | An approval decision. Not a contract, not an effective date. |
| Enrollment | The provider is added to a specific payer’s network and claims system, under the right NPI, tax ID and location. For Medicare and Medicaid this is the whole application (PECOS, the state Medicaid portal). | The practice or its credentialing service submits; the payer’s enrollment unit loads the record. | A provider record the payer can pay claims against. |
| Contracting | The practice and a commercial payer sign a participation agreement that sets the fee schedule and terms. Government programs use a standard agreement instead of a negotiated one. | The practice signs; the payer’s network or contracting team issues the agreement. | Rates, terms and, with enrollment, an effective date: the day the provider is in network. |
| Privileging | A hospital or facility grants a clinician permission to perform specific procedures on its premises, based on its own credentialing review. | The facility’s medical staff office and governing body, separate from any payer. | Permission to practice in that building. It does not make anyone in network with a payer. |
The practical consequence: a provider can clear credentialing and still be out of network, because enrollment and contracting are not finished. A hospital can grant privileges to a surgeon whom no payer has enrolled. And a Medicare approval does nothing for a Cigna claim. When someone says a provider is “done,” the only answer that matters for billing is a written effective date from that specific payer.
Enrollment and credentialing are also not always separate applications. For Medicare and Medicaid the enrollment application is the credentialing review. For commercial plans, credentialing usually runs first from the CAQH profile, and contracting follows only once the committee approves.
How long provider credentialing takes, payer by payer
Every figure below is the payer’s own published number, linked to the payer’s document. Every clock starts only when the application is complete.
Short answer: payers that publish a timeline publish very different ones, from UnitedHealthcare’s “generally up to 14 calendar days” to Florida Medicaid’s “60 days or less,” and third-party industry guides put typical commercial plans at 90 to 120 days. None of those clocks starts on the day you mail a form. Each one starts when the payer decides the application is complete, which is why a complete first submission matters more than anything a credentialing service does afterward.
| Payer | What the payer publishes | When the clock starts | Source |
|---|---|---|---|
| UnitedHealthcare | Generally up to 14 calendar days | Once UHC has a completed application and all required information; depends on responses from schools, boards and hospitals | UHC credentialing FAQ (July 2024) |
| Medicare (First Coast, Florida’s MAC) | 95% within 15 calendar days, 100% within 50 (online PECOS, no site visit); 95% within 50 and 100% within 85 with a site visit or fingerprinting | A clean CMS-855 application; other states’ Medicare contractors publish their own standards | First Coast processing timeframes (Feb 18, 2026) |
| Cigna | Typically 45 to 60 days | From a complete application | Cigna credentialing page |
| Florida Medicaid (AHCA) | 60 days or less | From receipt of a complete application; deficiencies must be corrected within 21 days or the application is denied | AHCA provider readiness page |
| Florida Blue | Written decision within 30 business days after committee review; if 90 days pass with no communication, the manual says to call | After the Credentialing Committee reviews a verified, complete file | Florida Blue Provider Manual, Section 01 |
| Humana | No overall figure. Licensure, board and malpractice verifications must be within 120 calendar days of the decision, all others within 180; written approval notice within 30 calendar days | These are freshness rules for verifications, not a promise of total time | Humana Credentialing Policy (May 2025) |
| Industry range (not a payer figure) | Typical commercial plans: 90 to 120 days | Reported by third-party credentialing guides; no payer publishes this range | Industry range, labelled as such |
Read the table as a set of checkpoints, not promises. If UnitedHealthcare has had a complete file for three weeks, something is waiting on someone, and the right move is to ask what. If Florida Blue has gone 90 days without a word, its own manual says to call. Payers that publish no overall figure, like Humana, still publish rules that matter: a verification older than Humana’s 120-day window has to be redone before its committee can approve the file, so a stalled application can quietly slide backward.
Vendor pages often quote ranges such as 60 to 180 days without naming a payer. We publish the payers’ own numbers instead and label the one industry range for what it is. For the full Florida detail, including paper Medicare applications and the AHCA deficiency window, see our Florida provider credentialing guide.
The provider credentialing process, step by step
Seven steps, in the order we run them. Most delays come from steps one, two and five, the parts a practice controls.
Credentialing rarely stalls for interesting reasons. It stalls because one document was missing, because a payer’s request sat in an inbox, or because nobody followed up for six weeks. The process below is built to remove those three failures.
1. Build the credential file once
We collect every license, the DEA registration, board certification or eligibility, malpractice face sheet and claims history, education and training records, a CV and a complete work history, then check each document against the others. Dates that disagree between a CV and a CAQH profile are a classic reason a payer sends a file back. Our credentialing document list shows exactly what we ask for and why.
2. Set up or clean up CAQH
Most commercial payers read credentialing data from CAQH ProView rather than from a form you send them. We build or repair the profile, upload current documents, authorize each payer to view it, attest it and put the next re-attestation on the calendar.
3. Sequence the payers
Not every payer moves at the same speed, so order matters. We start Medicaid and the Blue plans first, run commercial applications in parallel, and file Medicare through PECOS. When a practice is opening, the group enrollment and each individual provider are sequenced around the real opening date and payer mix, the way someone who has run a practice would do it.
4. Submit complete applications
One application per payer, per provider, with every attachment the payer lists, the correct individual and group NPIs, and the tax ID and service locations the claims will carry. Complete is the whole game: every published clock in the table above starts there.
5. Follow up until the file moves
Applications nobody chases are the ones that take six months. We follow up with every payer every week, log the representative, date, reference number and status, and answer any request for more information the day it arrives.
6. Contract and load
Once credentialing clears, commercial payers issue a participation agreement. We review it with you, return it, and confirm the provider is loaded under the right tax ID, location and specialty, because a record loaded wrong produces denials that look like billing errors.
7. Confirm the effective date in writing
A phone call that says “approved” is not an effective date. We get the date in writing, and for billing clients we hold new-provider claims until it arrives, then release them the same day.
What provider credentialing services cost
Flat, published fees, the same for every practice. No quote required.
| Service | Price |
|---|---|
CAQH profile setup or cleanup | $250 per provider, one-time |
Payer enrollment — commercial, Medicare, or Medicaid Aetna, BCBS Florida, Cigna, UnitedHealthcare, Humana, Medicare, Medicaid, and more | $250 per payer, per provider |
Re-credentialing / revalidation Same rate as initial enrollment | $250 per payer, per provider |
New-practice bundle CAQH + Medicare + Medicaid + 6 commercial payers · list $2,250 — saves $500 | $1,750 per provider |
Additional provider, same group & payers | $1,400 per provider |
Credentialing maintenance CAQH re-attestation, expirables monitoring, demographic and TIN updates — revalidation billed separately | $99 per provider / year, billed annually |
Every enrollment fee includes application preparation and submission, weekly payer follow-up until approval, and written confirmation of your effective date. Payer- or state-imposed application fees are passed through at cost.
Annual maintenance covers CAQH re-attestation (the 120-day clock), expirables monitoring, and demographic and TIN updates with each payer. Revalidation and re-credentialing applications are billed separately at the standard enrollment rate.
Timeline: it depends on the payer, and only some publish a number (Florida Medicaid 60 days or less from a complete file; UnitedHealthcare generally up to 14 calendar days; Florida Blue 30 business days after committee). Every clock starts only when the file is complete. We follow up weekly until you’re in-network — you’ll never wonder where an application stands.
Worked example: two providers joining eight panels
A two-provider practice wants both clinicians in eight networks: Medicare, Medicaid and six commercial plans. Neither has a CAQH profile yet.
| Option | Arithmetic | Total |
|---|---|---|
| Per application | 2 providers × 8 payers × $250 = $4,000, plus CAQH setup 2 × $250 = $500 | $4,500 |
| New-practice bundle | First provider: bundle (CAQH + Medicare + Medicaid + 6 commercial) $1,750. Second provider, same group and payers: $1,400 | $3,150 |
| Annual maintenance (optional) | 2 providers × $99 per year | $198 a year |
In this case the bundle saves $1,350 against paying per application. Payer- or state-imposed application fees are passed through at cost and never marked up. When re-credentialing or revalidation comes due, each application is $250, the same as initial enrollment. Maintenance covers CAQH re-attestation, expirables monitoring and demographic and tax-ID updates; it does not include revalidation applications.
Why publish exact prices when most credentialing companies ask you to call? Because the cost of credentialing is rarely the fee. It is the weeks a provider sees patients who cannot be billed. A flat fee you can see lets you compare that against what one month of unbillable visits is worth to your practice.
How often re-credentialing comes due
Credentialing is not a one-time project. Three separate clocks keep running after the effective date.
| Who | Cadence | Source |
|---|---|---|
| Health plans following NCQA standards | Recredential every three years (36 months) | NCQA |
| Medicare | Revalidate every five years (most providers); CMS can also request an off-cycle revalidation, answered within 60 calendar days of the notice | 42 CFR 424.515 |
| CAQH ProView | Re-attest every 120 days (180 days for providers practicing in Illinois) | CAQH ProView quick reference |
| Between cycles | State licenses, DEA registration and malpractice coverage each expire on their own dates; a lapse can interrupt network status before any re-credentialing date arrives | Each license, registration and policy |
The CAQH clock is the one that bites first. A profile that is not re-attested on time expires, and a payer that tries to read an expired profile during re-credentialing can stop processing the file. Medicare revalidation is the one practices forget, because five years is long enough for the person who did the first application to have left.
Our $99 per provider per year maintenance covers the CAQH re-attestation clock and expirables monitoring. Re-credentialing and revalidation applications are billed at the standard $250 per payer application when they come due, so you only pay for the cycles that actually arrive.
CAQH checklist: what a payer-ready profile needs
Most commercial payers will not open a file until the CAQH profile is complete, attested and authorized for that payer.
- CAQH ProView account and Provider ID: one profile per clinician, reused by every participating payer.
- Identity that matches NPPES exactly: legal name, individual NPI, practice and mailing addresses. A mismatch with the NPI registry is a common reason a file stalls.
- All state licenses, plus DEA registration and any state controlled-substance registration the provider holds.
- Education and training: professional school, residency and fellowship, with dates.
- Board certification or eligibility, with the board name and expiration date.
- Complete work history, with every gap explained in writing.
- Hospital affiliations or the provider’s admitting arrangement, where the specialty requires one.
- Malpractice coverage: current face sheet with limits and dates, plus claims history.
- Practice locations: tax ID, service addresses, office hours and whether the provider accepts new patients.
- Uploaded documents: license, DEA, malpractice face sheet, CV, W-9 and board certificate, all current.
- Payer authorizations: grant each health plan access to the profile, or it cannot open the file.
- Attestation, then a calendar entry: attest the profile and set the next re-attestation 120 days out (180 in Illinois).
“CAQH is done” is not “credentialing is done.” A complete, attested profile is the precondition each payer needs to start; each one still runs its own verification, its own committee and its own contracting step. CAQH profile setup or cleanup is $250 per provider, one time, and is included in the new-practice bundle.
New practice, new provider or new panel: what changes
The steps are the same. The order, the paperwork and the risk are not.
Opening a new practice
A new practice needs a group enrollment before its providers can be linked to it: the organization’s NPI, tax ID, service location and bank details come first, then each individual provider is enrolled and reassigned to the group. Lease, licensure and opening dates drive the sequence, which is why the new-practice bundle covers CAQH, Medicare, Medicaid and six commercial payers for one provider in a single fee.
Adding a provider to an existing group
The group is already in network, so only the new clinician’s file has to clear. That is usually simpler, but the provider still cannot be billed as in network until each payer confirms the effective date. A provider who has enrolled before, at another practice, often moves faster because the CAQH profile and primary-source records already exist; tell us which payers they are already in so we update rather than restart.
Behavioral health and specialty panels
Behavioral health benefits are often run by a carve-out organization with its own panel, separate from the medical plan, so a therapist can be in network with the medical plan and still out of network for the behavioral benefit. Chiropractors, physical therapists and other specialists face the same pattern with specialty and auto-injury networks. We map which entity actually pays the claim before we apply.
How to choose a provider credentialing service
Six questions to ask any credentialing company, including us, before you sign.
- Is the price published, per payer, in writing? A quote that depends on a discovery call is hard to compare. Ask what re-credentialing and maintenance cost too, not only the first application.
- Where do their timeline numbers come from? A range with no payer named is a guess. Ask which payer published it.
- What does follow-up look like? Ask for a sample status log: payer, date, representative, reference number, next action.
- Who owns the CAQH clock? Re-attestation every 120 days is the most common lapse. Find out whether it is included or extra.
- When is the job done? The only finish line that matters for billing is a written effective date for each payer, not an “approved” phone call.
- Will they sign a BAA? A credentialing file holds Social Security numbers, licenses and bank details. ClaimCarePro signs one.
Florida payers and our Clearwater base
ClaimCarePro provides provider credentialing services to practices in Florida and across the United States, run from Clearwater, FL.
Florida adds its own rules on top of the national ones. Florida Medicaid gives an applicant 21 days to correct a deficiency before the application is denied. Florida Blue reads CAQH and commits to a written decision within 30 business days of its committee. First Coast, the state’s Medicare contractor, publishes the most specific processing standards of any payer in the table above.
Every one of those rules, with the payer’s own document linked, is in our Florida provider credentialing guide, including what to do on day 21, day 50 and day 90 of a silent application. Practices in Pinellas County can start with credentialing services in Clearwater, FL; behavioral health practices should also read our mental health billing services page, because behavioral benefits are often run by a carve-out with its own panel.
Provider credentialing services: questions practices ask
Short answers to the questions practices search most, each one sourced in the sections above.
How long does provider credentialing take?
What is the provider credentialing timeline?
Is provider enrollment the same as credentialing?
How often do providers need to be credentialed?
What is the provider credentialing process?
Is credentialing the same as being in network?
What are credentialing services?
When should credentialing be performed?
How to start with ClaimCarePro
- 1
Send the roster and payer list
Tell us which providers and which payers. We price it from the published table before any work starts.
- 2
Upload documents once
You get a private upload folder. We build one credential file per provider and reuse it for every payer.
- 3
We submit, follow up and confirm
Applications go out complete, we chase every payer until it moves, and you get each effective date in writing.
Start Provider Credentialing
Tell us which payers you need. We will price it from the published table and handle everything from the first application to every future renewal. Call (727) 580-8186.