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Insurance Enrollment

Provider Enrollment With Medicare, Medicaid and Commercial Payers

Opening a practice, adding a provider or changing locations? Getwell Healthcare Solutions manages the enrollment paperwork and payer follow-up so you can bill the plans your patients rely on.

Request a Consultation Credentialing Services
  • Individual and group enrollment
  • PECOS, Medicaid and commercial applications
  • EDI, ERA and EFT setup
Doctor in a consultation room at a newly enrolled practice
Enrollment specialists updating payer portals on laptops

Overview

Why Enrollment Deserves Careful Attention

Each payer has its own forms, portals, supporting documents and processing times. Small inconsistencies, such as a practice address that differs between NPPES, PECOS and CAQH, can lead to returned applications or claims that do not pay.

We keep provider and group information consistent across every system, submit complete applications, and follow each one until the payer confirms an effective date and provider ID.

  • New practice and new provider enrollment
  • Group enrollment and reassignment of benefits
  • Location, ownership and tax ID changes
  • Revalidation and maintenance updates

What We Handle

Enrollment Services

NPI and NPPES

Obtain or update Type 1 (individual) and Type 2 (organization) NPIs and taxonomy codes.

Medicare (PECOS)

Initial enrollment, reassignment to a group, ordering/referring enrollment, changes and revalidation.

Medicaid

State Medicaid enrollment and applications with managed Medicaid plans where applicable.

Commercial payers

Applications with commercial and Medicare Advantage plans, including network participation requests.

EDI enrollment

Set up electronic claim submission with payers through your clearinghouse.

ERA and EFT

Enroll for electronic remittance advice and electronic funds transfer to speed posting and deposits.

Workflow

Our Enrollment Process

Processing times are set by each payer. Our job is to keep applications complete and moving.

  1. Collect information

    We gather provider, group, location, tax ID and banking details through a secure intake.

  2. Align profiles

    NPPES, CAQH ProView and PECOS records are reviewed so information matches everywhere.

  3. Submit applications

    Payer-specific applications are completed and submitted with required attachments.

  4. Track and respond

    We follow up regularly and respond to payer requests for additional information.

  5. Confirm and activate

    Effective dates and IDs are confirmed and shared with billing, and EDI, ERA and EFT are set up.

Good Practice

Tips to Avoid Enrollment Delays

Start early

Begin as soon as a provider's start date or new location is known. Payer processing can take weeks or months.

Keep data consistent

Use the same legal name, addresses and taxonomy across NPPES, CAQH, PECOS and payer applications.

Hold claims thoughtfully

Discuss with your billing team how to handle services rendered before approval, since payer rules differ.

Track revalidation dates

Medicare revalidation and payer re-credentialing dates should be on a shared calendar.

FAQs

Enrollment and Credentialing Questions

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.

Get Started

Need Providers Enrolled With New Payers?

Share your provider roster and target payers, and we will outline the applications and documents needed.

  • Mon–Fri 8am–8pm ET
Request a Consultation Call (445) 300-7597

Consultation

Request an Enrollment Consultation

Tell us about your practice, the number of providers and the payers you want to work with. We will follow up to discuss next steps.

  • Review of current enrollment status
  • Payer-by-payer action plan
  • Ongoing maintenance options

Tell Us About Your Practice

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