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Credentialing services

Insurance Credentialing Services | PPS

Commercial payer enrollment for physicians and groups. PPS runs payer applications in parallel, not sequence, cutting average credentialing from 180+ days to 90-120.

Insurance credentialing is the operational gate between a licensed physician and a billable patient. If you can’t bill the payer, you can’t get paid — no matter how many patients walk in the door. PPS runs commercial payer enrollment for individual physicians and groups in all 50 states. The work itself isn’t glamorous: it’s portal logins, document tracking, follow-up calls, escalation when a payer sits on an application past their stated turnaround. What we sell is the operational discipline to do it in parallel — across every payer your practice needs — instead of in sequence, which is what most billing companies and in-house teams quietly do.

What’s included

Every credentialing engagement includes the following, per provider:

  • Application packet preparation — CAQH profile audit and update, malpractice COI confirmation, NPI verification, DEA and state license confirmation, hospital privileges letters where required.
  • Parallel payer submission — we file with every payer in your panel concurrently. Most carriers we work with regularly: Aetna, Anthem/BCBS plans, Cigna, Humana, UnitedHealthcare, Tricare, plus regional carriers, Medicaid plans by state, and the Medicare enrollment (handled via our Medicare Provider Enrollment workflow).
  • Weekly tracker — a shared status sheet showing every payer, application date, projected effective date, and current state.
  • Payer follow-up — we escalate any application past 60 days of silence. This is where in-house credentialing usually breaks down: nobody calls.
  • Re-attestation calendar — CAQH attestation every 120 days, payer-specific recredentialing reminders synced to your provider roster.
  • Effective-date confirmation — written confirmation from each payer before we close the engagement.

How it works

The full workflow has four phases. We’ll tell you up front which phase you’re in and what the realistic timeline looks like from there.

Phase 1 — Intake & document audit (week 1). We pull every credentialing document on file, audit it against payer requirements, and flag gaps. Common gaps: expired malpractice COIs, outdated CAQH profile, missing peer references, board certification verification pending.

Phase 2 — Parallel submission (weeks 2-4). Applications go out to every payer concurrently. We don’t wait for one to come back before starting the next. This is the single biggest delta between us and in-house credentialing teams.

Phase 3 — Follow-up & escalation (weeks 4-16). Most of the calendar time. We’re calling payers, responding to requests for additional documentation, escalating stalled applications to provider-relations supervisors.

Phase 4 — Effective-date confirmation (week 12-20). Each payer comes back with an effective date — sometimes retroactive, sometimes prospective. We confirm in writing and hand off the final roster to your billing team.

Average completion across our credentialing book: 90 to 120 days from intake to fully credentialed in standard commercial payers. Medicare and some Medicaid plans run longer (often 150+ days) for reasons outside any vendor’s control.

Who this is for

You’re a good fit for this service if:

  • You’re a solo physician launching a new practice and need to be billable by a specific date.
  • You’re an established group adding a provider and don’t want them sitting in a non-billable seat for six months.
  • You’ve outgrown your billing company’s credentialing add-on and need someone whose entire job is credentialing.
  • You’ve tried doing this in-house and the recredentialing calendar has gotten ahead of you.

You’re a poor fit if you need single-payer enrollment only (we can do it, but it’s not a great economic fit) or if you’re a hospital health-system size operation with internal medical staff services already in place.

Why parallel matters

Most in-house credentialing teams — and most billing-company credentialing add-ons — submit payer applications sequentially. Aetna goes in. Three weeks later UnitedHealthcare goes in. Three weeks after that Cigna. The reason is workflow: one person can only track so many open files. The result is six to nine months to full enrollment instead of three to four. We staff credentialing as its own function and submit in parallel from day one. That’s the entire delta.

We also keep written records of every payer call. When a payer says “we received that application on March 3” and the portal says otherwise, we have the call log. That gets you back-dated effective dates we can negotiate, which translates to billable encounters from the day you first saw patients.

What you should ask any credentialing vendor

Before signing with anyone, including us, ask:

  • How many active credentialing files do you have per credentialer?
  • Do you submit in parallel or sequence?
  • Do you track CAQH re-attestation, and what’s your re-attestation lapse rate?
  • What’s your average days-to-effective for commercial payers?
  • Who calls the payer when an application sits — your team or mine?

If the answers are vague, that’s the answer.

Get started

Tell us your specialty, state, the payers you need to be in, and your target billing date. We’ll come back with a scoped quote and a realistic timeline.

Start a credentialing scope call — or read about our Credentialing & Enrollment Process for the full operational picture.