Home/Credentialing/Medical Credentialing Services
All specialties · all 50 states · $250 per application

Medical credentialing services. Every specialty, every payer.

Credentialing and payer enrollment run as one managed file: CAQH ProView hygiene, Medicare through PECOS, state Medicaid, commercial panels, group and individual linkage, then a re-credentialing calendar that keeps the network status you paid to get. Flat $250 per application, no platform fee.

Start a credentialing file → See the $250 rate card
Reviewed Reviewed by Aparna Suresh, CPB, President, ASP-RCM Solutions Updated September 17, 2026 ASP-RCM Solutions · Frisco, Texas
Our standard rate
$250
Per application, one provider to one payer
Coverage
50 states
Medicare, Medicaid and commercial payers
Scope
All specialties
Physician, mid-level, therapy, behavioral, facility
After go-live
Expirables tracked
License, DEA, malpractice, board, CAQH attestation

The scopeWhat credentialing and payer enrollment actually cover.

The two words get used interchangeably and they are not the same work. Credentialing is verification: the payer, or a delegated entity, confirms education, training, licensure, board certification, work history, malpractice coverage and sanctions status, usually by going back to the primary source rather than trusting the application. Enrollment is the administrative step that follows: loading the verified provider into the payer's claims system under the right group, tax ID and service location so that claims actually adjudicate. Contracting is a third workstream that sets the rate. A provider can clear credentialing and still have claims deny, because enrollment landed at the wrong location or the group link was never made.

A complete file usually touches all of the following:

1

CAQH ProView

The shared profile most commercial payers read. Attestation lapses roughly every 120 days, and a stale profile stalls applications at intake with no notice back to the practice.

2

Medicare via PECOS

CMS-855I for individuals, 855B for groups, 855R for reassignment of benefits, plus the enrollment application fee where it applies, filed through the PECOS portal.

3

State Medicaid

Every state runs its own portal, its own screening level and its own revalidation cycle. Managed care plans in the state frequently require a separate enrollment on top of fee-for-service.

4

Commercial panels

Each payer has its own intake desk, its own roster process and its own closed-panel rules. Some open only for a specialty shortage in a county, which changes the strategy, not just the paperwork.

5

Group vs individual

Individual credentialing verifies the person and their Type 1 NPI. Group enrollment loads the organization, its Type 2 NPI and TIN. Both have to be complete and correctly linked before a claim pays.

6

Re-credentialing and revalidation

Commercial payers generally re-credential on a three-year cycle. Medicare revalidation runs on a five-year cycle, three for DMEPOS suppliers. Medicaid adds its own.

Delegated credentialing

When a group is large enough to credential its own providers.

Under a delegated agreement, the payer hands primary-source verification and committee review to the group, and the group sends a roster instead of individual applications. Turnaround collapses from months to a roster cycle. The trade is real: NCQA-aligned files, a credentialing committee, documented policies, and an annual payer audit that you have to pass. Delegation is the right answer for a group adding providers continuously and the wrong answer for a practice adding two a year. We build and maintain audit-ready files either way, and help groups decide whether delegation is worth the compliance overhead.

The costEnrollment gaps do not show up as denials. They show up as write-offs.

A credentialing gap is quiet. Nothing errors out at the point of service, the schedule fills, the notes get written, and the money disappears one or two steps downstream where nobody is looking for it. Four patterns account for most of it.

Pattern 1
Unenrolled rendering provider
Claims go out under a supervising or partner NPI because the real rendering provider is not enrolled. It pays, then it gets recouped, and it is a compliance exposure, not a billing shortcut.
Pattern 2
Missed retro-effective date
The payer grants an effective date back to application receipt, but nobody captured it, so the held claims are never released and time out against timely filing.
Pattern 3
Claims held with no owner
Charges sit in a hold bucket waiting for enrollment that has already gone live. AR ages, the bucket is never worked, and the balance quietly becomes a write-off.
The fix
One tracked file
Effective date captured in writing, held claims released the same week, and every expirable on a calendar with an owner and a date.
TAKEAWAY The expensive part of credentialing is rarely the application. It is the weeks after approval when nobody released the held claims, and the month after a license expired when nobody noticed.

The fourth pattern is the lapse. A state license, DEA registration, malpractice certificate, board certification or CAQH attestation runs out, the provider drops out of network, and reinstatement is usually a fresh application rather than a correction. Lapses are the most preventable revenue loss in the entire revenue cycle.

Our processFive stages, one owner, a date on everything.

We do not promise a turnaround the payer controls. We promise that nothing in the file is ever waiting on us, and that you always know which stage each provider is in.

1
Stage 1

Intake and validation

Every document checked against the payer's own requirement list before anything is submitted. Most rejected applications fail here, not on merit.

2
Stage 2

CAQH and NPPES

Profile built or repaired, attested, payer authorization set, and the NPPES record reconciled to the same taxonomy, address and legal name.

3
Stage 3

Parallel submission

Medicare, Medicaid and commercial applications go out together rather than one after another. Serial submission is where most of the calendar is lost.

4
Stage 4

Follow-up cadence

Scheduled contact per payer, with escalation when an application ages past that payer's normal window. Every touch is logged with a name and a date.

5
Stage 5

Effective date and release

The effective date is captured in writing, held claims are released against it, and the re-credentialing date goes on the calendar the same day.

Typical first-time commercial applications run 60 to 120 days at the payer. Medicare through PECOS commonly runs 30 to 90 days. On our ABA line, where we run the highest file volume and the payer mix is narrow, BCBA credentialing averages 22 days. That is the ABA number, and we do not extend it to specialties where the payer behaves differently.

What we need from youThe pack that decides how fast this goes.

A complete pack on day one is the single biggest factor in turnaround that either side controls. This is the whole list for a typical individual provider file.

✓

Identity and numbers

Individual Type 1 NPI, group Type 2 NPI, TIN and W-9, CAQH ID, and a signed W-9 matching the legal entity name exactly.

✓

Licensure

Current state license for every state you intend to bill in, DEA registration and state controlled-substance registration where applicable.

✓

Education and training

Diploma, residency and fellowship certificates, board certification, ECFMG where relevant, and a work history with no unexplained gaps.

✓

Insurance

Professional liability certificate showing current limits and dates, plus the claims history the payer asks for.

✓

Practice information

Every service location with address, hours, phone, accessibility details, hospital affiliations and admitting arrangements, and a coverage plan.

✓

Attestations and signatures

Disclosure questions answered, an attested CAQH profile, and signature authority identified so nothing waits on a countersignature.

Facility and group files add the organizational layer: ownership and managing control disclosures, accreditation certificates, CLIA where applicable, and the state facility license.

ScaleMulti-state and multi-specialty, handled as one roster.

A group with providers in four states and three specialties does not have one credentialing problem. It has a matrix, and the failure mode is always the cell nobody owned.

Multi-state

State rules, not general rules

Licensure, Medicaid screening level, managed care enrollment and telehealth eligibility all change at the state line. We hold the requirement set per state rather than applying one template everywhere.

Multi-specialty

Taxonomy is not cosmetic

The taxonomy code on the NPPES record drives which panel the provider lands on and which claims adjudicate. A mismatch between NPPES, CAQH and the application is a silent, common rejection.

Re-credentialing

A calendar, with owners

Every provider, every payer, every cycle date on one calendar with an owner and a lead time, so re-credentialing starts before the payer sends the notice rather than after.

Expirables

Tracked to the date

License, DEA, malpractice, board certification and CAQH attestation each carry their own clock. We track them with staged reminders, because the lapse is far more expensive than the renewal.

How we workIn your system, at $250 an application.

Two things people ask before anything else: what does it cost, and do we have to buy your software.

Pricing

$250 per application

One provider to one payer is one application. Same rate across specialties, same rate for re-credentialing and revalidation. No platform fee, no per-provider monthly, no setup charge. The full rate card is on the pricing page.

Systems

Your stack, not ours

We work inside the credentialing module, practice management system or spreadsheet you already run. Where a client has nothing, we run the file on our own Credential OS platform and hand over the record, in a format you keep.

Ownership

One named owner per file

A specialist owns the roster, not a ticket queue. You get a status view by provider and payer, and a senior partner on the account rather than an escalation path you have to discover.

Credentialing is the front door. What happens after it is the Credential OS platform, and for practices that want the claims handled too, our full RCM engagements pick up from the first billable date.

FAQMedical credentialing, asked and answered.

How much does a credentialing service cost?
ASP-RCM charges a flat $250 per application. One application means one provider submitted to one payer, so a physician going to eight payers is eight applications. The rate is the same whether the file is a physician, a nurse practitioner, a therapist or a facility, and it covers the full cycle: document validation, CAQH work, submission, the follow-up cadence, and capture of the effective date. Re-credentialing and Medicare revalidation are billed the same way, as one application each. Our full rate card is on the pricing page.
How long does credentialing take?
Plan on 60 to 120 days per payer for a first-time commercial panel application, and 30 to 90 days for Medicare through PECOS, though Medicaid varies widely by state. The payer's own review clock is only part of it. Most of the calendar is lost before submission, to incomplete document packs, and after submission, to applications that nobody chases. On our ABA line, where we run the highest file volume, BCBA enrollment averages 22 days.
What is the difference between credentialing and enrollment?
Credentialing is verification. The payer confirms the provider's education, training, licensure, board certification, work history, malpractice coverage and sanctions status, usually through primary-source verification. Enrollment is the administrative act of loading that verified provider into the payer's claims system under a specific group, tax ID and service location so claims adjudicate. Contracting is a third thing again: it sets the fee schedule and the network terms. A provider can be credentialed and still not be enrolled at the right location, which is why claims deny even after the approval letter arrives. All three have to close before the first clean claim pays.
What is CAQH and do I need it?
CAQH is a nonprofit alliance of health plans, and its provider data platform, ProView, is the shared profile most commercial payers read instead of asking each provider for the same documents again. In practice, yes, you need it. If your CAQH profile is unattested, missing a current malpractice certificate, or carries a stale practice location, commercial applications stall at intake with no notice to you. Attestation is required roughly every 120 days. Keeping CAQH clean is the single cheapest thing a practice can do to shorten every commercial application it will ever file. See CAQH ProView and CAQH provider data management.
Can I bill before credentialing is complete?
Usually not, and billing a service under a different rendering provider because the real one is not enrolled yet is a compliance problem, not a workaround. Some payers grant a retroactive effective date back to the application receipt date, and some Medicaid programs backdate further. Where a retroactive date is available, the correct move is to hold the claims, capture the effective date, and release the held batch once enrollment is live. Where it is not available, the service is simply not billable to that payer.
What happens if a provider's credentialing lapses?
The provider drops out of network. Claims deny as non-participating or as an invalid rendering provider, patients get billed at out-of-network rates they did not agree to, and reinstatement is usually a fresh application rather than a quick fix, so the gap can run months. Lapses almost never come from the payer. They come from an expirable that quietly ran out: a state license, a DEA registration, a malpractice certificate, a board certification, or a CAQH attestation that went past its window. That is why the re-credentialing calendar matters more than the initial submission.
What are the best medical credentialing platforms?
There is no single best one, and we do not resell any of them. The market splits into four categories. Payer-side and shared-profile utilities such as CAQH ProView and the government portals, PECOS for Medicare and each state's Medicaid portal, which you have to use regardless. Dedicated credentialing and provider data management systems, which manage files, expirables and primary-source verification. Practice management and EHR modules that carry a lightweight credentialing tracker alongside scheduling and billing. Spreadsheets, which is still what most groups under about twenty providers actually run on. ASP-RCM works inside whatever the client already owns, and where a client has nothing, we run the file on our own Credential OS platform and hand over the record.
Does Medicare revalidation apply to me?
If you are enrolled in Medicare, yes. CMS requires every enrolled provider and supplier to revalidate their enrollment on a cycle, generally every five years, and every three years for DMEPOS suppliers. CMS posts the due date and mails a notice ahead of it, and missing the date can deactivate the billing privileges you already have. State Medicaid agencies run their own revalidation cycles on top of that, and several states are working through enlarged revalidation backlogs through 2026, so a provider can be current with Medicare and overdue with Medicaid at the same time. Check your date on the CMS revalidation page and the CMS revalidation due date list, and ask your state Medicaid agency for its own cycle.

Primary sources

State Medicaid revalidation cycles are set by each state agency. Check your own state's provider enrollment portal for its current cycle and any 2026 revalidation backlog notices.

Go deeperThe rest of the credentialing stack.

Platform

Credentialing & Payer Enrollment

The Credential OS platform behind the service: audit-ready packets, continuous primary-source verification, and re-credentialing that does not miss a deadline.

/credentialing/ → ABA variant

BCBA Credentialing Services

The ABA-specific version of this page: BACB verification, RBT supervision structure, parallel commercial and Medicaid submission, and a 22-day average turnaround.

/bcba-credentialing-services/ → Specialty

Behavioral & Mental Health Billing

Behavioral health panels have their own enrollment desks and their own closed-panel behaviour. Here is how the billing side runs once enrollment is live.

/specialties/behavioral-mental-health-billing-services/ → Specialty

ABA Billing Services

Authorizations, session-note compliance, clean claims and denial management for ABA organizations, once the BCBAs are enrolled.

/specialties/aba-billing-services/ →

Tell us the providers, the states and the payers. We will count the applications.

No estimate theatre. Send the roster and the payer list and you get back an application count at $250 each, a stage plan per provider, and the re-credentialing calendar that comes with it.

Start a credentialing file See the rate card