Provider Enrollment & Credentialing
Provider enrollment is where reimbursement is won or lost before a single claim is filed. We prepare and manage NPI registration, Medicare enrollment through PECOS, Texas Medicaid enrollment, commercial credentialing and CAQH maintenance — and we track revalidation so a missed deadline never deactivates your billing privileges.
What is included
- NPI application and maintenance through NPPES, for both individual and organizational identifiers
- Medicare enrollment through PECOS, including CMS-855A, CMS-855B, CMS-855I and CMS-855R reassignment as applicable
- Texas Medicaid enrollment and maintenance through TMHP
- Commercial payer credentialing applications and follow-through
- CAQH ProView profile creation, attestation and ongoing maintenance
- Revalidation calendar and monitoring so cycle deadlines are met in advance
- Change-of-information filings for address, ownership, managing employees and banking details
- Resolution of enrollment denials, returns and development requests
How the engagement runs
- Inventory — we document every provider, location, tax identification number and payer relationship in scope, and identify what is already on file.
- Gap analysis — expired attestations, unreported changes, missing reassignments and approaching revalidation dates.
- Filing — applications prepared, submitted and tracked to approval, with every development request answered inside its response window.
- Maintenance — a calendar of attestation and revalidation dates, monitored so nothing lapses.
Who this is for
Newly forming groups, established practices adding providers or locations, organizations recovering from a deactivation, and any group without a single owner of the credentialing calendar.
Frequently asked questions
What happens if we miss a Medicare revalidation deadline?
Missing a revalidation deadline can result in a hold on payments and, if it goes unresolved, deactivation of billing privileges. Reactivation is possible but the gap in the effective date can leave a period of unbillable services. This is why we treat the revalidation calendar as a monitored asset rather than a reminder.
Which CMS-855 form applies to us?
Broadly: CMS-855A for institutional providers, CMS-855B for clinics, group practices and certain suppliers, CMS-855I for individual physicians and non-physician practitioners, and CMS-855R to reassign benefits to a group. The right answer depends on your provider type and how you intend to bill, and getting it wrong costs months.
How long does commercial credentialing take?
Commercial timelines vary by payer and by whether the network is open to your specialty in your county. The single largest accelerant is a complete, attested CAQH profile at the moment of application.
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Start this engagement
Tell us your provider type, your timeline and what has already been filed or attempted. That is usually enough for a scoped answer.