Credentialing Services

STARTING A PRACTICE?

We’ll manage the entire process of getting you credentialed with insurance payers and contracted at the right rates. Our services ensure your practice is recognized as an in-network provider, fully enrolled in Medicaid or Medicare, and ready to bill all major payers.

CREDENTIALING VS CONTRACTING

Many providers use these terms interchangeably—but they are two distinct (and equally critical) processes:

Credentialing:

This is the payer’s process of verifying your license, education, experience, liability insurance, and other qualifications.

Contracting:

Once credentialed, the payer issues a participation agreement that determines your rates, billing terms, and network status.

If either step is skipped or done incorrectly, you won’t get paid—or worse, you may unknowingly work out-of-network for months.

CREDENTIALING PROCESS:

• CAQH profile creation or updates
• NPPES/NPI setup and alignment
• Medicaid and Medicare enrollment (including Colorado-specific HCPF systems)
• Roster additions for practice groups
• Credentialing with commercial payers like Aetna, Anthem/BCBS, Cigna/Evernorth, UnitedHealthcare/Optum, TriWest, and more
• Documentation collection and management (license, liability insurance, W-9, etc.)

We manage every step, track application status, follow up with payers, and troubleshoot delays so you don’t have to.

CONTRACTING SERVICES:

• Submission of participation requests to payers
• Negotiation of contract terms and fee schedules when applicable
• Review of contracts and rate sheets
• Assistance with “single case agreements” or non-par contracts
• Medicaid RAE network enrollment (Colorado Access, CCHA, RMHP, etc.)
• Group vs. individual NPI enrollment guidance

We also help ensure your contracts reflect your correct taxonomy codes, specialties, locations, and billing structure, so you don’t lose out on reimbursement due to setup errors.