Medical Credentialing Services That Get You In-Network Faster
247 Medical Billing is a leading medical credentialing company helping physicians, group practices, and healthcare organizations get credentialed with Medicare, Medicaid, and 1,200+ commercial insurance payers in weeks, not months.
- Provider Enrollment & Insurance Credentialing for All Specialties
- CAQH Profile Setup, Maintenance & Attestation
- Medicare / Medicaid / PECOS Enrollment
- Re-Credentialing & Payer Contract Renegotiation
- 30% Faster Credentialing Than Industry Average
HIPAA
Compliant
NCQA
Standards
CMS
Certified
CAQH
Partner
Our Medical Credentialing Services
The Numbers Don't Lie. Credentialing Delays Are Costing Your Practice
Every day without proper provider credentialing is revenue you’ll never recover. Here’s what the industry data says.
$7,500
Lost Per Day
Average revenue a practice loses for every day a provider isn’t credentialed
61%
Practices Affected
Of healthcare practices experience at least one active credentialing lapse at any given time
90–120
Days Average
Standard credentialing timeline, we cut that down significantly with proactive management
11.8%
Claim Denial Rate
Current initial claim denial rate, most caused by credentialing gaps, enrollment errors, or lapsed status
📊 Industry Fact: Healthcare organizations with optimized credentialing processes experience 30% fewer claim denials related to provider enrollment issues. Don’t be part of that 61%. Contact us today →
Understanding Medical Credentialing
What Is Medical Credentialing & Why Does Your Practice Need It?
Medical credentialing is the formal process through which healthcare organizations and insurance payers verify a provider’s education, training, licensure, board certifications, work history, and professional standing — confirming they are qualified and authorized to deliver patient care and receive insurance reimbursement.
Without active, verified credentialing with each insurance payer, your practice cannot bill or collect reimbursement for services rendered to insured patients — even if those services were medically necessary and properly coded.
Medical credentialing services also encompass provider enrollment (registering with individual payers), insurance credentialing (joining payer networks), physician credentialing (verifying individual doctors), and hospital privileging (granting clinical privileges at facilities).
| Medical Credentialing | Provider Enrollment | |
|---|---|---|
| Purpose | Verifies provider qualifications | Registers provider with a specific payer |
| Happens | First — prerequisite step | After credentialing is approved |
| Platform | CAQH ProView, NPPES | PECOS (Medicare), payer portals |
| Result | Provider is verified & qualified | Provider is in-network & can bill |
Comprehensive Medical Credentialing Company
Full-Spectrum Medical Credentialing
Services For Physicians, Groups &
Healthcare Organizations
From initial provider enrollment to ongoing re-credentialing management 247 Medical
Billing handles every aspect of the credentialing process so your practice never misses a
beat.
Provider Enrollment Services
Complete provider enrollment with all major insurance payers Medicare, Medicaid, CHIP, and 1,200+ commercial plans. We handle all application preparation, submission, follow-up, and confirmation so you can start billing faster.
— Medicare Enrollment
— Medicaid Enrollment
— Commercial Plans
— Group Enrollment
Physician Credentialing Services
Comprehensive physician credentialing covering license verification, board certification, education history, malpractice insurance, DEA registration, work history, and peer references submitted accurately the first time.
— MD Credentialing
— DO Credentialing
— NP Credentialing
— PA Credentialing
Re-Credentialing Services
Proactive re-credentialing management with automated deadline tracking, document updates, CAQH re-attestation, and payer revalidation cycles. We ensure your credentials never lapse protecting your revenue stream 247.
— CMS Revalidation
— CAQH Attestation
— License Renewal
— Annual Re-enrollment
CAQH Profile Setup & Maintenance
We create, complete, and continuously maintain your CAQH ProView profile the centralized credentialing database used by 900+ health plans. We handle attestations, document uploads, and profile accuracy so payers always have current data.
— CAQH ProView
— Profile Attestation
— Document Management
— Continuous Monitoring
NPI Registration & PECOS Enrollment
We handle Type I (individual) and Type II (organization) NPI registration with NPPES, and full PECOS portal management for Medicare enrollment ensuring accurate taxonomy codes, provider data, and enrollment status.
— NPI Type I & II
— NPPES Registration
— PECOS Portal
— Taxonomy Codes
State Licensing & DEA Registration
Full-service support for state medical license applications, renewals, and verification across all 50 states. We also handle DEA certificate processing, CLIA registration, board certification tracking, and specialty-specific licensing.
— State Licenses
— DEA Registration
— CLIA Registration
— Board Certifications
Hospital Privileges & IPA Enrollment
Streamlined hospital medical staff credentialing and privileges application to expand your practice scope. We also handle Integrated Provider Association (IPA) enrollment including closed panels opening doors other companies can’t.
— Hospital Privileges
— IPA Enrollment
— Closed Panels
— Medical Staff Credentialing
Payer Contract Negotiation
We negotiate payer contracts on your behalf securing higher reimbursement rates, favorable fee schedules, and better contract terms. Our expertise across commercial payers helps you maximize revenue per patient encounter.
— Contract Review
— Rate Negotiation
— Fee Schedule
— Network Expansion
EDI, ERA & EFT Enrollment
We set up and enroll your practice for Electronic Data Interchange (EDI), Electronic Remittance Advice (ERA), and Electronic Funds Transfer (EFT) with all payers accelerating payment posting and eliminating paper remittances.
— EDI Setup
— ERA Enrollment
— EFT Registration
— Electronic Payments
Our Medical Credentialing Process
6-Step Medical Credentialing Process - From Application To
Approval
Our structured, proven credentialing workflow eliminates guesswork, reduces delays,
and gets your practice billing with payers 30% faster than the industry average.
-
Free Consultation & Needs Assessment
We begin with a comprehensive consultation to understand your practice type, specialties, locations, target payers, and current credentialing status. Our specialists identify gaps, priorities, and timeline expectations at no cost to you.
-
Document Collection & Verification
Our credentialing specialists provide a customized checklist and collect all required documentation medical school diplomas, residency certificates, board certifications, state licenses, DEA registration, malpractice insurance, CV, and work history.
-
CAQH Profile Setup & Application Preparation
We build or update your CAQH ProView profile with all verified data, then prepare payer-specific credentialing applications with complete, accurate information. Every detail is reviewed before submission to prevent costly delays.
-
Payer Submission & Application Tracking
Applications are submitted simultaneously to all targeted payers. Our team provides real-time tracking with transparent status updates you always know exactly where each application stands with each payer at any moment.
-
Proactive Follow-Up & Payer Communication
We proactively follow up with every payer on a consistent schedule, respond to additional information requests, clarify payer questions, and resolve any issues immediately dramatically accelerating approval timelines.
-
Approval Confirmation & Ongoing Maintenance
Upon approval, we confirm effective dates, document network participation, and immediately establish a re-credentialing calendar to prevent future lapses. Your dedicated account manager monitors all credentials continuously going forward.
Typical Medical Credentialing Timeline
Industry average vs. 247 Medical Billing performance
Medicare Enrollment
Commercial Payers
Medicaid Enrollment
Required Documentation
Medical Credentialing Documents Checklist - What You Need To Get Started
Incomplete or inaccurate documentation is the #1 cause of credentialing delays and denials. Our credentialing specialists provide a customized document checklist for your specific specialty and target payers and verify every document for accuracy before submission.
Education & Training
- Medical School Diploma
- Residency/Fellowship Certificate
- Internship Completion Letter
- Board Certification(s)
- CME Credits Documentation
Licensure & Registration
- State Medical License(s)
- DEA Registration Certificate
- NPI (Type I & II)
- CLIA Registration (if applicable)
- CDS Controlled Substance Certificate
Professional History
- Curriculum Vitae (CV)
- Work History Verification
- 3–5 Professional References
- Malpractice Insurance Certificate
- Loss Run Report (5+ years)
Personal & Identity
- Government-Issued Photo ID
- Social Security Number
- Birth Certificate or Passport
- Authorization for Background Check
- CAQH ProView Authorization
⚡ Pro Tip: Missing even a single document can delay your credentialing by 30–60 days. Our team provides a specialty-specific, payer-specific checklist and assists you in gathering every required item — nothing gets overlooked.
Avoiding Credentialing Denial
Top Reasons Medical Credentialing Applications Get Denied - And How We Prevent Them
Why 5,000+ Providers Choose 247 Medical Billing
What Makes 247 Medical Billing the Best Medical Credentialing Company In The USA?
We’re not just another credentialing vendor. We’re your long-term credentialing partner with the experience, technology, and dedication to keep your practice in-network and revenue flowing.
247 Medical Billing vs. Other Medical Credentialing Companies
| Feature | 247 Medical Billing | Typical Competitors |
|---|---|---|
| Dedicated Account Specialist | ✓ Named specialist | ✕ Shared team / call center |
| Real-Time Status Portal | ✓ 24/7 online access | ⚠ Email updates only |
| Credentialing Timeline | ✓ 30% faster than avg | ✕ Industry average or slower |
| Re-Credentialing Management | ✓ Fully proactive | ⚠ Reactive (you remind them) |
| Payer Contract Negotiation | ✓ Included in service | ✕ Separate add-on fee |
| CAQH Maintenance | ✓ Continuous monitoring | ⚠ Setup only |
| All 50 States Coverage | ✓ Nationwide | ⚠ Limited states |
| EDI/ERA/EFT Setup | ✓ Included | ✕ Separate billing |
| IPA & Closed Panel Enrollment | ✓ Specialized expertise | ✕ Not offered |
| HIPAA Compliance | ✓ Certified | ✓ Standard |
Medical Specialties We Credential
Medical Credentialing Services for Every Specialty-Solo Providers to Large Groups
Whether you're a single physician just starting your practice or a multi-location group with dozens of providers, 247 Medical Billing provides expert credentialing services tailored to your specialty's unique requirements.
Compliance & Regulatory Standards
Medical Credentialing Compliance — NCQA, CMS,
CAQH, HIPAA, and Beyond
Credentialing is a heavily regulated process. 247 Medical Billing maintains expertise across every major credentialing compliance framework keeping your practice fully protected and audit-ready.
National Committee for Quality Assurance
Our credentialing processes adhere to NCQA standards the gold standard for credentialing verification organizations (CVOs). NCQA compliance ensures consistent, accurate, and defensible credentialing practices.
Centers for Medicare & Medicaid Services
Full compliance with CMS enrollment rules, PECOS portal management, revalidation cycles, and Medicare/Medicaid enrollment requirements including the new 3-year revalidation cycle for high-risk specialties.
Council for Affordable Quality Healthcare
Authorized CAQH ProView experts managing your centralized credentialing profile used by 900+ health plans. We ensure continuous accuracy, timely attestations, and document compliance.
Health Insurance Portability & Accountability Act
All credentialing data is handled under strict HIPAA compliance with encrypted storage, secure transmission, access controls, and signed Business Associate Agreements (BAAs) for full legal protection.
Provider Enrollment, Chain & Ownership System
Expert PECOS portal management for Medicare enrollment, revalidation, reassignment of benefits, and ownership updates ensuring accurate, timely Medicare participation status.
Division of Health & Family Services
State Medicaid compliance expertise across all 50 states managing Medicaid provider enrollment, revalidation, and compliance with state-specific DHFS and Medicaid agency requirements.
What Is CAQH and Why Is It Critical for Your Practice?
CAQH ProView (formerly UNIFORMdata Services) is the industry-standard, centralized database where over 900 health plans collect provider credentialing data. Maintaining an accurate, up-to-date CAQH profile is mandatory for insurance credentialing with virtually every major payer.
Payers use CAQH to verify your licenses, certifications, education, work history, and insurance information. If your CAQH profile is incomplete, inaccurate, or not attested, payers will flag or reject your credentialing application regardless of how perfect the rest of your paperwork is.
247 Medical Billing manages your CAQH profile end-to-end from initial creation and data entry to continuous maintenance, quarterly attestation, and document updates so your profile always reflects accurate, current information.
Q: How often does CAQH require re-attestation?
A: CAQH ProView requires re-attestation every 120 days. Missing this window deactivates your profile and stalls credentialing with all connected payers simultaneously.
Q: Can I use CAQH for all payers?
A: CAQH is accepted by 800+ health plans including Aetna, Cigna, UHC, BCBS, Humana, and most commercial payers. Some payers like Medicare use PECOS separately.
Q: What happens if my CAQH profile has errors?
A: Errors in your CAQH profile propagate to every payer that pulls your data, potentially delaying credentialing across your entire payer network simultaneously a costly problem we prevent proactively.
Medical Credentialing FAQs
Frequently Asked Questions About Medical Credentialing
The average medical credentialing timeline is 90 to 120 days, depending on the payer and completeness of the application. Medicare enrollment typically takes 60 to 90 days. Commercial payers vary between 30 and 180 days. Working with an experienced credentialing service like 247 Medical Billing helps reduce delays by submitting complete, accurate applications and conducting consistent payer follow-up.
Standard documents required for medical credentialing include:
- Current medical license(s)
- DEA certificate (if applicable)
- Board certification certificate
- Curriculum vitae (CV) with full work history
- Malpractice insurance certificate
- NPI number (Type 1 and/or Type 2)
- CAQH ProView profile
- State-issued photo ID
- Social Security Number or Tax ID
- Hospital affiliations (if applicable)
247 Medical Billing provides providers with a complete personalized document checklist at the start of the engagement.
CAQH ProView is a centralized, universal credentialing database used by more than 1,000 health plans and hospitals to collect and verify provider data. A complete and up-to-date CAQH profile is required by most commercial payers before they will process a credentialing application. Providers must re-attest their CAQH information every 120 days to keep it active. 247 Medical Billing manages CAQH setup, completion, and ongoing re-attestation on behalf of providers.
While CMS controls the official processing timeline for Medicare PECOS enrollment — typically 60 to 90 days — 247 Medical Billing minimizes delays by submitting complete, error-free applications the first time. We also identify whether a provider qualifies for expedited processing in certain circumstances, and we follow up proactively with CMS to prevent applications from stalling.
Most insurance payers require re-credentialing every 2 to 3 years. The exact schedule varies by payer. Medicare requires providers to revalidate enrollment every 5 years. Missing a re-credentialing deadline can result in temporary or permanent removal from a payer's network. 247 Medical Billing tracks all renewal timelines and initiates the re-credentialing process well in advance of each deadline.
If a payer denies a credentialing application, 247 Medical Billing immediately investigates the reason for denial, gathers any additional documentation required, and submits an appeal or corrected application. Most denials result from incomplete documentation, licensing issues, or malpractice history concerns — all of which our specialists are trained to address. We communicate denial status and next steps to providers promptly.
Credentialing is the process of verifying a provider's qualifications, education, and professional history. Provider enrollment is the process of registering with an insurance payer to be included in their network and authorized to receive reimbursement. In practice, the two processes happen simultaneously, and the terms are often used interchangeably. 247 Medical Billing manages both processes together as part of a complete credentialing engagement.
Yes. 247 Medical Billing regularly credentials new providers joining established group practices, ensuring they are enrolled with all relevant payers before they begin seeing patients. We coordinate with the group's existing payer relationships to add the new provider efficiently and minimize any gap in billing capability.
Ready To Get Your Practice In-Network Faster?
Stop losing $7,500/day to credentialing delays. Our medical credentialing specialists are ready to get you enrolled with every payer you need — quickly, accurately, and affordably.