Provider Credentialing and Enrollment, Handled Quickly and Correctly
Practices launching or expanding, we manage the credentialing and insurance enrollment process with precision and speed.
Scope of Service
- CAQH profile setup and ongoing management
- Medicare PECOS enrollment support
- NPI registration and update assistance
- Commercial payer enrollment support
- Re-credentialing tracking and maintenance
Simple, Transparent Pricing
3%
of collections
Flat fee · No hidden costs
CREDENTIALING
Credentialing Is the Foundation of Getting Providers Paid
Provider credentialing is the foundation of getting providers paid. Until your providers are properly credentialed and enrolled with insurance payers, your practice cannot submit claims through our medical billing services—which means delayed revenue, regardless of how many patients you treat.
Grace RCM Solutions’ provider credentialing and enrollment service manages the process from the initial application through ongoing maintenance, allowing your providers to focus on patient care while we manage the administrative work.
WHY IT MATTERS
Why Proper Credentialing Matters
For new practices, credentialing can be the biggest barrier between opening your doors and receiving insurance payments. For established practices adding providers, credentialing delays can result in:
Weeks or Months Without Billing
Treating patients without being able to bill their insurance.
Retroactive Billing Restrictions
Rules that differ by payer and can easily be overlooked.
Significant Revenue Loss
Losses that can reach $20,000-$50,000+ per provider for each month of delay.
Patient Access Limitations
Providers cannot participate with certain insurance plans.
Credentialing can be complicated, with every payer having different forms, documentation requirements, and processing timelines. One missing document or incorrect detail can delay enrollment for weeks.
OUR SUPPORT
Our Enrollment & Credentialing Support
From CAQH to Medicare PECOS, we manage the applications and the follow-up.
CAQH Profile Administration
CAQH ProView is a widely used credentialing database relied upon by many health plans. We manage:
- Profile setup with accurate and complete provider information
- Document submission including licenses, certifications, and insurance documents
- Quarterly attestations to keep profiles current and active
- Re-attestation reminders to help prevent profile deactivation
Maintaining an accurate CAQH profile helps streamline enrollment with participating payers.
Medicare PECOS Registration
Medicare enrollment through the PECOS (Provider Enrollment, Chain, and Ownership System) portal comes with specific requirements:
- Individual and group enrollment applications (CMS-855I, CMS-855B)
- Benefit reassignment to your group practice
- Medicare specialty changes and updates
- Revalidation support when required by Medicare, typically every 5 years
Medicare enrollment delays can impact revenue. Medicare generally pays only for services provided after the provider’s effective enrollment date. Unlike certain commercial payers, retroactive billing is generally unavailable. Accurate PECOS submission from the beginning is essential.
COMMERCIAL PAYERS
Commercial Insurance Enrollment
We coordinate enrollment with major commercial insurance payers:
- Blue Cross Blue Shield (regional plans)
- UnitedHealthcare / Optum
- Aetna / CVS Health
- Cigna / Evernorth
- Humana
- State Medicaid programs
- Regional and specialty payers relevant to your market
Each payer follows its own enrollment process and documentation standards, and our team ensures applications are prepared according to those requirements.
NPI & RENEWALS
NPI Setup and Credential Maintenance
Credentialing does not end after initial enrollment. We keep every identifier and credential current.
NPI Setup & Updates
Every healthcare provider needs a National Provider Identifier (NPI) for insurance billing. We assist with:
- Type 1 NPI registration for individual providers
- Type 2 NPI registration for organizations and group practices
- NPI updates when practice details change
- NPI deactivation when providers leave the organization
Credential Renewal & Maintenance
Many payers require re-credentialing every 2-3 years, while licenses, DEA certificates, and malpractice coverage follow separate renewal schedules. We monitor important expiration dates and coordinate renewals proactively:
- Expiration tracking for licenses, certifications, and credentials
- Re-credentialing applications submitted ahead of deadlines
- CAQH attestation reminders every 120 days
- Payer roster updates when provider or practice information changes
THE DIFFERENCE
The Grace RCM Solutions Difference
Our credentialing specialists manage applications on an ongoing basis. This helps provide:
- Fewer application errors through payer-specific requirements knowledge
- Faster processing with complete applications submitted correctly
- Fewer missed deadlines through credential and renewal tracking
- Concurrent payer submissions to targeted plans instead of handling them one at a time
Standard Enrollment Timelines
| Payer Type | Average Timeline | With Grace RCM Solutions |
|---|---|---|
| Commercial payers | 90-120 days | 60-90 days |
| Medicare (PECOS) | 65-85 days | 60-65 days |
| Medicaid | 90-120 days | 75-90 days |
| CAQH profile setup | 2-3 weeks | 5-7 business days |
HOW IT WORKS
Our Credentialing & Enrollment Workflow
Our organized process helps providers complete enrollment efficiently and maintain active payer participation.
01
Credentialing Document Review
We collect required records—licenses, certifications, malpractice coverage, employment history, and education details.
02
Enrollment Application Preparation
Our team prepares CAQH profiles, PECOS applications, and payer-specific enrollment forms accurately to minimize processing issues.
03
Payer Submission & Follow-Up
Applications are submitted to selected payers, followed by consistent status checks to help keep enrollment moving.
04
Credential Maintenance & Renewal
We monitor credential expiration dates and coordinate renewals and re-credentialing to help prevent enrollment interruptions.
MORE SERVICES
Related Services
End-to-End Medical Billing
Complete revenue cycle management from charge capture to payment posting, backed by a 97% clean-claim rate.
Benefits Verification / Eligibility
Real-time eligibility and benefits checks before services are rendered, preventing denials before they happen.
Compliance Support / Regulatory
Scheduled reviews of billing procedures ensure continuous alignment with HIPAA, current AMA coding guidance, and CMS regulations.
Optimize Your Practice’s Revenue Cycle Today
Don’t let claim denials, coding mistakes, and inefficient billing quietly drain your revenue. Request a free billing audit now and see how Grace RCM Solutions can improve and grow your collections.