Provider records, payer applications and follow-ups kept organized, so new providers can bill sooner and nobody’s enrollment lapses.
CAQH, NPI and payer applications handled
Our medical credentialing services get your providers approved by the insurance plans your patients use, then keep those approvals current. Until a provider is credentialed and enrolled with a payer, claims for their visits cannot be paid.
Credentialing is the payer checking a provider’s licenses, training and history. Enrollment is the contract step that links the provider to your group so claims pay. Both have to be done, and both have to be kept up to date.
Missed revalidations, expired documents and unanswered payer requests quietly stop revenue. We track every date and follow up with each payer until the provider is approved.
Our credentialing services cover physicians, nurse practitioners, physician assistants, therapists and other providers, for new practices and growing groups.
We build and maintain CAQH ProView profiles and complete re-attestation every 120 days so payers can always see current data.
Applications go to each payer you want the provider enrolled with, including Medicare, Medicaid and commercial plans.
We link providers to your group, update NPPES records and keep taxonomy codes consistent with enrollment.
Medicare revalidation is required every five years. We track it with each payer’s re-credentialing cycle so nothing lapses.
We follow up with each payer until the application is approved and effective dates are confirmed.
Licenses, DEA registrations, board certifications and malpractice coverage are stored and renewed on time.
A clear process from paperwork to your first paid claim.
We gather licenses, certifications, malpractice coverage, work history and other required records.
Applications go to each payer, including the Texas Standardized Credentialing Application where Texas plans use it.
We track each application, answer payer requests and confirm the effective date.
Re-credentialing, revalidation and document expirations are tracked so enrollment never lapses.
Our insurance credentialing services include the payers Texas practices bill most. Each has its own forms, portals and timelines.
Medicare
Enrollment through CMS PECOS; Texas claims are processed by Novitas Solutions
Texas Medicaid
Enrollment through TMHP, then with each managed care plan (STAR, STAR+PLUS, STAR Kids, CHIP)
Commercial plans
Blue Cross Blue Shield of Texas, UnitedHealthcare, Aetna, Cigna and Humana each run their own credentialing
CAQH ProView
Most commercial payers pull provider data from CAQH, so it must stay current
Approval times vary by payer and can take weeks or months. Starting early and answering payer requests quickly is the best way to shorten the wait.
Our physician credentialing services follow the same order every time, so nothing is missed:
Hiring a new provider? Tell us the start date as early as possible. Credentialing is one of the few billing tasks that cannot be rushed at the end.
Our provider enrollment services go beyond the first application. Practices change: providers join and leave, groups add locations, and tax IDs or addresses change. Each change has to be reported to every payer, or claims start to deny.
We also help behavioral health groups, therapists and ABA providers get enrolled. See our mental health billing page for details.
Most credentialing delays come from a handful of avoidable errors. We check for each one before an application goes out.
An expired attestation or missing document stops review at many payers.
Addresses, names or taxonomy codes that differ between CAQH, NPPES and the application.
Unexplained gaps trigger payer questions and extra review.
A license or malpractice certificate that expires mid-review sends the file back.
Applications sit for weeks when nobody answers payer requests.
Beginning credentialing after the provider’s start date means weeks of visits that cannot be billed.
New providers can see insured patients and get paid as soon as payers approve them.
Revalidations and expirations are tracked, so claims do not start denying for enrollment reasons.
Your office manager is not chasing payer portals and fax confirmations.
Getting started
Five simple steps from the first call to clean monthly reports.
1
Tell us about your practice, payers and how provider enrollment runs today. We reply within one business day.
2
We look at your open A/R, denial patterns and payer mix, and show where revenue is slipping.
3
We work inside your EMR, practice management software and clearinghouse. No software switch.
4
Our team takes over provider enrollment on an agreed start date, with one point of contact for your staff.
5
Weekly or monthly reports show what was filed, paid and still open, and what we fixed.
It depends on the payer. Some approvals take a few weeks and others take several months. Starting early and responding quickly to payer requests keeps the process moving.
Typically a state medical license, DEA registration if applicable, board certification, malpractice insurance, work history, education and training records, and an NPI.
CAQH ProView is a shared database most commercial payers use to review provider data. Profiles must be re-attested every 120 days, or payers may stop processing applications.
Yes. We enroll providers with Medicare, Texas Medicaid through TMHP and its managed care plans, and commercial payers across Texas.
Our Austin team supports practices across Texas, including Houston and Dallas, and in all 50 states.
It depends on the payer. Medicare can allow billing back to 30 days before the application was filed in many cases, but commercial plans and Medicaid plans set their own rules. Seeing patients before approval risks denied claims, so we confirm each payer’s effective date before scheduling.
Yes. We keep a calendar of license, DEA, board, malpractice and payer re-credentialing dates for every provider. Your team gets reminders well before each deadline, so no provider drops out of network because a document expired.
Tell us about your practice. A billing specialist will get back to you within one business day.
5900 Balcones Drive STE 100, Austin, TX 78731
Open 24 hours, 7 days a week
Tell us about your providers and payers. The consultation is free, and we reply within one business day.
