Medical Credentialing & Payer Enrollment Services
Get your providers enrolled, contracted, and in-network faster. We handle the paperwork, the payer follow-up, and the deadlines so you can start billing sooner and stop losing revenue to lapsed enrollments.
Start Credentialing TodayCredentialing is where revenue quietly leaks. A provider who isn't enrolled with a payer can't be paid by that payer. Every visit billed before the effective date is a write-off, and every missed revalidation deadline can deactivate you overnight. PRMS Billing Solutions manages the entire credentialing lifecycle for practices, groups, and facilities across the United States, so your providers stay in-network with every payer that matters.
Our full credentialing & enrollment services
We don't just "submit applications." We own the process end to end and chase every payer until your provider is live.
Provider Enrollment & Credentialing Verification
New enrollments with Medicare, Medicaid, and all major commercial payers (Aetna, Cigna, UnitedHealthcare, BCBS, Humana and more), including primary-source verification of licenses, education, and work history.
CAQH Setup & Ongoing Attestation
Full CAQH ProView profile creation or takeover, document uploads, and re-attestation every 120 days so payers always pull a current, complete record.
Payer Contract Negotiation
We review fee schedules and negotiate participating-provider contracts so you aren't locked into below-market rates for years.
New Practice & Facility Setup
NPI Type 1 & Type 2 registration, group enrollment, EDI/ERA/EFT setup, and clearinghouse connections, everything a new practice needs to bill from day one.
Re-Validation & Re-Credentialing
We track every re-credentialing cycle and Medicare revalidation deadline and file ahead of time, so you're never deactivated or forced to bill out-of-network.
Provider Demographic Updates
Address changes, new locations, added providers, and payer roster maintenance, kept current across CAQH and every payer to prevent claim rejections.
Why credentialing delays cost you money
Every payer has an effective date, the day your provider is officially in-network. Claims for services before that date are usually denied with no appeal. When credentialing drags on for 90 to 120 days because an application was incomplete or nobody followed up, that's three to four months of a new provider's production billed out-of-network or written off entirely.
The same is true in reverse: miss a Medicare revalidation or a commercial re-credentialing deadline and the payer can deactivate the provider, freezing payments until you re-enroll. PRMS prevents both by treating deadlines as hard commitments, not reminders.
How our credentialing process works
- Discovery & document collection. One organized request for licenses, DEA, malpractice, board certificates, and IDs.
- CAQH & application prep. We build clean, complete applications the first time to avoid the #1 cause of delay: rework.
- Submission & weekly payer follow-up. We call and portal-check payers every week so nothing sits idle in a queue.
- Effective-date confirmation. You get written confirmation of each in-network date so billing starts on time.
- Ongoing maintenance. Attestations, expirables, revalidations, and demographic changes handled for as long as you're a client.
Credentialing FAQs
How long does provider credentialing take?
Most commercial payer enrollments take 60 to 120 days, and Medicare or Medicaid typically 45 to 90 days, depending on the payer and how complete the application is. PRMS shortens this by submitting clean, complete applications the first time and following up with payers weekly so nothing sits in a queue.
Do you handle CAQH setup and attestation?
Yes. We create or take over your CAQH ProView profile, keep it fully attested, upload and refresh expirables (license, DEA, malpractice), and re-attest every 120 days so payers never pull an outdated record.
Is credentialing really free with your billing service?
Yes. Provider enrollment and credentialing are provided free of charge to our active medical billing clients. Standalone credentialing (without billing) is available at a flat per-provider, per-payer rate.
Can you re-credential providers and handle Medicare revalidation?
Absolutely. We track every re-credentialing cycle and Medicare revalidation deadline (every 5 years for most providers, 3 for DMEPOS) and file ahead of time so you are never deactivated or forced to bill out-of-network.
Do you credential new practices and add providers to existing groups?
Yes. New practice or facility setup (NPI Type 2, group contracts, EDI/ERA/EFT enrollment) and adding or linking individual providers to an existing group are both core services.
What is insurance credentialing?
Insurance credentialing is the process of verifying a provider and enrolling them with a payer so they can bill as an in-network provider. It combines credentialing (verifying licenses, education, and work history) with enrollment and contracting (getting an effective date with each payer).
How do I get credentialed with insurance companies?
You get credentialed by submitting a complete application to each payer, backed by a current CAQH profile and primary-source-verified credentials, then following up until an effective date is issued. Because every payer has its own forms and timeline, most providers use a credentialing service to submit clean applications and chase each payer to approval.
Why is credentialing important?
Credentialing is what lets a provider be paid by a payer. Without it, claims to that payer are denied, usually with no appeal. It also protects you from lapses: a missed revalidation or re-credentialing deadline can deactivate a provider and freeze payments until you re-enroll.
What is PECOS and do I need it to bill Medicare?
PECOS is the Provider Enrollment, Chain, and Ownership System, the online system Medicare uses for provider enrollment. Every provider must be enrolled and active in PECOS before billing Medicare, and enrollment must be revalidated every five years (three for DMEPOS).
How do I enroll with a payer like Aetna, Cigna, or UnitedHealthcare?
You submit an enrollment application to the payer, backed by a current, attested CAQH profile, then work through their contracting process to an in-network effective date. Each commercial payer has its own portal and timeline. We handle enrollment with all major payers as part of credentialing.
What is a CVO in credentialing?
A CVO is a Credentials Verification Organization, a body that performs primary-source verification of a provider’s credentials on behalf of payers or health systems. Many payers rely on a CVO or on CAQH to verify licenses, education, and work history during credentialing.
Credentialing is one part of a healthy revenue cycle
Getting in-network is step one. Getting paid correctly and quickly is the rest. PRMS pairs credentialing with full-service medical billing, certified coding, denial management, and AR follow-up, so a newly credentialed provider is set up to collect every dollar from the first claim. We bill for 25+ specialties, each with a specialty-trained coding team.
New to outsourcing? Read how to reduce claim denials in your practice.