Insurance Credentialing & Provider Enrollment
At InsuranceCareRCM, we provide complete insurance credentialing and enrollment services to help healthcare providers get contracted, stay compliant, and receive timely reimbursements.
Our credentialing specialists manage the entire process with accuracy and transparency ensuring providers are properly enrolled with Medicare, Medicaid, and commercial payers so claims are accepted without delays or denials. All documentation is handled through HIPAA-compliant workflows with secure records management and DocuSign-supported agreements.
Medical Credentialing & Provider Enrollment
We handle end-to-end provider credentialing for individual providers, group practices, and healthcare organizations. Our team ensures that all applications are completed accurately, supported with required documentation, and submitted according to payer-specific guidelines.
This includes credentialing for physicians, NPs, PAs, behavioral health providers, therapists, and other allied healthcare professionals.
PPO, Medicare & Medicaid Contracting
We manage contracting and enrollment with:
Medicare (PECOS)
State Medicaid programs
Commercial & PPO plans (Aetna, Cigna, UnitedHealthcare, BCBS, Humana, and others)
Our team works directly with payers to track application status, respond to requests, and follow up until approvals are finalized reducing enrollment timelines and preventing revenue loss.
CAQH Setup & Profile Management
A complete and accurate CAQH profile is essential for payer enrollment and revalidation. We create, verify, and maintain CAQH profiles, ensuring all provider data is current and attested on time. We also manage document uploads, re-attestations, and payer linkages to avoid delays in credentialing or payment interruptions.
Revalidation & Ongoing Credential Maintenance
Medicare and commercial payers require periodic revalidation to keep provider enrollments active. Missing deadlines can result in claim denials or payment suspension. We proactively monitor revalidation timelines, submit required updates, and manage ongoing credential maintenance so providers remain compliant and uninterrupted.
Group & Facility Credentialing
We specialize in comprehensive credentialing services designed for group practices, multi-provider clinics, and healthcare facilities of all sizes. Our credentialing team manages every step of the enrollment process so your providers can begin billing quickly and compliantly across Medicare, Medicaid, and commercial insurance plans.
Our credentialing support includes:
Group NPI and Tax ID Enrollment: Establish or update your group’s National Provider Identifier (NPI) and link it properly to your federal Tax ID for accurate payer reporting. Location & Provider Add-Ons: Add new practice locations and onboard additional providers to your existing group enrollment ensuring that each location and provider is credentialed with the correct payer relationships.
Primary Source Verification (PSV): We handle verifications of licenses, certifications, education, work history, and board certifications directly with issuing agencies, per payer requirements. Payer Contracting & Updates: From initial payer applications to contract negotiations and updates, we ensure your practice is listed correctly with all major commercial carriers, Medicare, and Medicaid. This includes managed care plans and network participation agreements.
Recredentialing & Updates: We monitor expiration dates for licenses, certifications, and payer recredentialing requirements to keep your records current and prevent enrollment lapses. Credentialing Tracking & Follow-Up: Through regular follow-ups with payers and state entities, we reduce delays and prevent credentialing backlogs delivering you a consolidated tracking report and status updates.
CAQH & Portal Management: We manage your CAQH ProView profile and all payer portal submissions to ensure consistency, accuracy, and compliance, reducing the risk of application denials or requests for additional documentation. Our credentialing services help eliminate administrative burden, reduce payer onboarding delays, and improve reimbursement timelines. Whether you’re adding providers to an existing group or launching a new facility, we ensure your credentialing process meets current payer standards and compliance requirements across the U.S. healthcare ecosystem.
Demographic Updates & Payer Changes
We proactively manage and maintain accurate provider and practice information across all major payers to ensure uninterrupted reimbursements and compliance.
Our services include:
Practice and provider address updates (service, billing, and correspondence addresses)
Tax ID (TIN) changes, ownership updates, and group structure modifications
Banking updates, EFT/ERA enrollments, and payment method changes
Adding or removing providers, locations, and specialties
NPI updates (Individual & Group) and NPPES profile maintenance
CAQH profile updates and annual re-attestations
Payer portal updates (Medicare, Medicaid, MCOs, and commercial plans)
Revalidation and change-of-information submissions with CMS and commercial payers
With increasing payer audits, stricter CMS timelines, and frequent revalidation requirements, accurate demographic records are critical. Our structured approach helps
Credentialing Status Tracking & Reporting
We provide clear visibility into the credentialing process with regular status updates and documentation tracking. Practices always know where applications stand and what steps are pending.