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Provider Credentialing

Credentialing and Enrollment Handled From Application to Approval

Getwell Healthcare Solutions prepares, submits and follows up on credentialing and payer enrollment applications so your providers can see patients and bill without avoidable delays.

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  • CAQH ProView setup and re-attestation
  • Medicare, Medicaid and commercial payers
  • Expiration and re-credentialing tracking
Physician reviewing credentialing information on a tablet
Doctor holding a tablet with provider records

The Basics

What Is Provider Credentialing?

Credentialing is the process payers and facilities use to verify a provider's qualifications, including education, training, licensure, board certification, work history and malpractice history. Enrollment is the related step of getting the provider set up to bill a specific payer and, for commercial plans, often joining its network through a contract.

The two are closely linked. A provider who is not credentialed and enrolled with a payer generally cannot be reimbursed in-network by that payer, and claims submitted before approval may be denied. Because payer timelines vary and can run for months, starting early and following up consistently matters.

  • Verification of licenses, certifications and training
  • Payer applications and network participation
  • Enrollment for billing, EDI and electronic payments
  • Ongoing maintenance and re-credentialing

Provider Enrollment

Getting Each Provider Set Up Correctly

Individual and group enrollment steps we prepare and manage.

NPI Type 1 and Type 2

Confirm or obtain individual and organizational NPIs and keep NPPES information current.

Medicare via PECOS

Initial enrollment, reassignment of benefits to groups, and revalidation for Medicare.

State Medicaid

Medicaid provider enrollment and applicable managed Medicaid plan applications.

More on Provider Enrollment
Credentialing specialist completing payer enrollment forms

Payer Enrollment

Commercial Payer Enrollment and EDI Setup

For commercial payers, we submit credentialing applications, track them through the payer's review and committee process, and follow up on contracting where applicable. Once a provider is approved, we help complete the enrollments that make billing work smoothly.

  • Commercial and managed care plan applications
  • EDI enrollment for electronic claims
  • ERA enrollment for electronic remittance
  • EFT enrollment for direct deposit
  • Provider directory and demographic updates

CAQH Management

CAQH ProView Profiles Kept Complete and Current

Many commercial payers pull provider data from CAQH ProView. An incomplete or expired attestation can stall applications.

Profile setup

Create new profiles and complete every required section.

Document uploads

Upload current licenses, certificates and insurance documents.

Re-attestation

Track and complete periodic re-attestation on schedule.

Payer authorization

Grant access to the payers reviewing the provider's profile.

Provider organizing licenses and certificates for credentialing

Documentation

Credentialing Documentation Checklist

Having documents ready at the start is one of the most effective ways to keep applications moving. Requirements vary by payer and provider type, but most applications draw on the items below. We provide a secure way to share them.

  • Current state license(s) and DEA / controlled substance registration if applicable
  • Board certification or eligibility documentation
  • Medical or professional school diploma and training certificates
  • Curriculum vitae with month/year work history and explanations for gaps
  • Professional liability insurance certificate and claims history
  • NPI numbers and CAQH ProView login
  • Hospital privileges or admitting arrangements if applicable
  • Practice location, tax ID (W-9) and ownership information
  • Government-issued ID and supporting disclosures
Clinic front office where provider records are maintained

Re-Credentialing

Staying Credentialed After Approval

Credentialing is not a one-time task. Payers commonly re-credential providers every two to three years, Medicare requires periodic revalidation, and licenses, DEA registrations, malpractice policies and CAQH attestations all expire on their own schedules.

We maintain a calendar of these dates for each provider and start renewals ahead of time, reducing the risk of a lapse that could interrupt payments.

  • Expiration tracking for licenses and certificates
  • Payer re-credentialing and Medicare revalidation
  • CAQH re-attestation reminders and completion
  • Updates for address, group or ownership changes

Insurance Panel Applications

Joining Insurance Panels

Especially common for therapists and behavioral health providers, panel applications often include network availability checks and contracting steps.

Payer research

Identify the payers your patients use and whether their networks are open in your area.

Application and follow-up

Submit panel requests and applications, and follow up on status until a decision is issued.

Contract and effective date

Help review contract paperwork and confirm the participation effective date before billing.

Our Workflow

How Our Credentialing Process Works

Timelines depend on each payer, but our process stays consistent.

  1. Intake

    We gather provider details, target payers and existing documents through a secure intake.

  2. Profile preparation

    NPPES, CAQH ProView and PECOS profiles are reviewed and brought up to date.

  3. Application submission

    Payer-specific applications are completed and submitted with supporting documents.

  4. Follow-up

    We follow up with each payer on a regular cadence and respond to requests for information.

  5. Approval and enrollment

    Effective dates and provider IDs are confirmed, and EDI, ERA and EFT enrollment is completed.

  6. Ongoing maintenance

    Expirations, re-attestations and re-credentialing are tracked going forward.

FAQs

Credentialing FAQs

Common questions about credentialing and payer enrollment.

Still have questions?

Talk with a licensed insurance professional.

(445) 300-7597 Mon–Fri 8am–8pm ET

Provider credentialing is the process of verifying a healthcare provider’s qualifications and enrolling them with insurance payers so they can bill for services. It includes reviewing education, licenses, certifications, and work history. Proper credentialing is essential for getting reimbursed by insurance companies.

Credentialing timelines vary by payer and state, and the process can often take several months. Submitting complete, accurate applications and following up consistently can help avoid unnecessary delays. We manage these steps and keep you informed along the way.

We can assist with enrollment in Medicare, Medicaid, and many commercial insurance plans. The right payer mix depends on your specialty, location, and patient population. We will help you prioritize the payers that matter most to your practice.

Typically, we will need details such as your professional licenses, NPI, DEA registration if applicable, board certifications, malpractice insurance, education, and work history. We provide a clear checklist so you know exactly what to gather. Keeping your CAQH profile current is also important.

Yes. Payers generally require providers to re-credential periodically. We track upcoming deadlines and help you submit updated information on time to avoid interruptions in network participation.

Yes. We help new practices get set up with payers and help groups add new providers to existing contracts. Starting early is recommended so that providers can begin billing as soon as possible.

We can help create, update, and maintain your CAQH ProView profile, including periodic re-attestation. An accurate, current profile helps payer applications move forward smoothly.

Adding a Provider?

Start Credentialing Before the First Patient Visit

Payer processing can take time. Reach out as early as possible so applications are underway well before your provider's start date.

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Consultation

Request a Credentialing Consultation

Tell us how many providers you have and which payers you are targeting.

We will review where each provider stands today, identify missing items and outline a plan for applications and ongoing maintenance.

  • Review of current credentialing status
  • List of payers and documents needed
  • Plan for re-credentialing and expirations

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