Credentialing & Contracting Services
Every day without active payer enrollment is revenue you can't recover. Go Medical Billing manages the entire credentialing lifecycle so you never lose a billable day.
Why Practices Trust Our Credentialing
CAQH Profile Management
We build, maintain, and attest your CAQH ProView profile so it never lapses and delays enrollment.
Payer Specific Knowledge
We know the enrollment rules for Aetna, BCBS, Cigna, UHC, Humana, Medicare, and Medicaid in every state.
Fee Schedule Negotiation
Before you sign any contract, we benchmark rates against Medicare and regional averages. If they're low, we negotiate.
Re-credentialing Calendar
We track every provider and payer combination and start re-credentialing 90 days before expiration.
Get a Free Credentialing Billing Assessment
We'll review your current billing and show you exactly where revenue is leaking.
What Medical Credentialing Involves
Credentialing is the formal process of verifying a provider's qualifications, then submitting that verified profile to each insurance payer for enrollment. It covers education verification, board certifications, DEA registration, malpractice claims history, work history, and state licensure. Every payer has its own application format, documentation requirements, timeline, and re-verification cycle (typically every 36 months). Without active enrollment, your billing and coding team can't submit claims to that payer at all.
A single provider joining three payer networks can generate 40+ pages of paperwork, dozens of follow-up calls, and a 90 to 120 day wait before the first claim can be submitted.
Our Credentialing Process
CAQH ProView Setup
We build and maintain your CAQH profile with all required documentation, keeping attestations current so your profile never lapses.
Application Assembly
We gather state licenses, DEA certificates, NPI verification, malpractice certificates, board certifications, and work history. Each application follows that payer's specific format.
PECOS Medicare Enrollment
We handle Medicare Part B enrollment, reassignment of benefits, and practice location updates. For 2026, the CMS enrollment fee is $750 for institutional providers.
Commercial Payer Submissions
We submit to Aetna, BCBS (all state plans), Cigna, UnitedHealthcare, Humana, and regional plans. We track every application and escalate stalls.
Contract Negotiation
We review proposed fee schedules against Medicare benchmarks. If rates are below market, we negotiate for better terms.
Why Credentialing Gaps Cost You Money
Retroactive billing limits. Most payers only allow claims back to the enrollment effective date. A 120 day delay is 120 days of unrecoverable revenue that even aggressive A/R recovery can't fix.
Out of network defaults. Without active enrollment, claims process at OON rates or get denied outright. Patients get surprise bills. Our OON negotiation team can fight underpaid claims, but proper credentialing avoids the problem entirely.
Staff turnover. When a provider leaves, their enrollments don't transfer. Every new hire needs fresh applications.
Common Credentialing Mistakes That Delay Enrollment
After processing thousands of provider applications, we see the same mistakes causing delays over and over. Each one adds weeks or months to your enrollment timeline.
Incomplete CAQH profiles. CAQH ProView requires 100% completion and current attestation. A single missing field — a lapsed malpractice certificate, an unverified practice address, an outdated DEA registration — stalls every application that references your CAQH profile. We audit every profile field before submission and set attestation reminders 30 days before expiration.
Wrong application forms. Payers update their enrollment applications regularly. Submitting an outdated form results in automatic rejection. Some payers have separate forms for individual providers versus group practices, for Medicare reassignment versus initial enrollment, or for different product lines (commercial, Medicare Advantage, Medicaid managed care). We maintain current versions of every payer's application library.
Missing follow up. Most payer credentialing departments are understaffed. Applications sit in queue unless someone calls to check status. Our credentialing coordinators follow-up on a defined schedule: 2 weeks after submission, then weekly until a decision is issued. We document every call with the representative's name, reference number, and stated timeline.
Tax ID and NPI mismatches. When a provider's Type 1 NPI (individual) doesn't match the Type 2 NPI (organization) on file with the payer, claims get denied even after enrollment is approved. We verify NPI registry data against every payer record before the first claim goes out.
Group Practice Credentialing Challenges
Group practices face unique credentialing complexities that solo providers don't encounter. Every provider in the group needs individual enrollment with every payer the practice accepts, but each enrollment must also be linked to the group's Tax ID and billing NPI. When these linkages break, claims deny.
Provider onboarding. When a new physician or mid-level joins your practice, the clock starts immediately. They can't bill under the group until their individual enrollment is linked to your group contract. For a practice that bills $40,000 to $60,000 per provider per month, a 90-day enrollment delay represents $120,000 to $180,000 in deferred revenue — per provider. We start the application process before the provider's first day whenever possible.
Provider departures. When a provider leaves, their enrollments need to be terminated properly. If they're not, claims for other providers can get tangled with the departed provider's records. We handle termination notifications to every payer and verify that the group's roster is clean.
Multi-state practices. Telemedicine has expanded many practices across state lines. Each state has its own Medicaid enrollment process, and some commercial payers require separate credentialing for each state. A provider licensed in three states who accepts five payers could need 15 or more separate enrollment applications. We manage the full matrix across all 50 states.
Locum tenens coverage. Temporary providers need enrollment too, or your practice needs to bill under a supervising provider's credentials with correct modifiers. We advise on the fastest path to get locum providers billing-ready without compliance risk.
Payer Contract Negotiation: What Most Practices Miss
Credentialing and contracting are two distinct processes. Credentialing verifies that you're qualified. Contracting determines how much you get paid. Most practices accept the first fee schedule a payer offers without negotiation. That's a mistake that compounds every year.
Payer fee schedules are typically expressed as a percentage of Medicare rates. A contract that pays 110% of Medicare might sound reasonable until you discover that similar practices in your area are getting 125% to 140%. The difference on a single CPT code might be $15 to $30, but multiplied across thousands of claims per year, that's tens of thousands in lost revenue.
Go Medical Billing reviews every proposed contract against three benchmarks: Medicare fee schedule rates, FAIR Health regional data, and the rates we've negotiated for comparable clients. If your proposed rates are below market, we prepare a counter-proposal with data to support higher reimbursement. We've successfully negotiated rate increases of 8% to 25% for practices that were previously accepting default rates.
We also review contract terms beyond fee schedules: timely filing deadlines (shorter deadlines mean more claim risk), appeal procedures, medical necessity criteria, and termination clauses. A bad contract isn't just about low rates — it's about terms that make it harder to collect what you've earned.
Frequently Asked Questions
Stop Losing Revenue to Enrollment Delays
Every day without active credentialing is money you can't recover. Free consultation, no obligation.