Credentialing and enrollment services
PPS supports practices and hospitals with payer applications, enrollment, and related work. The exact providers, locations, and payers are defined in your proposal. Read client reviews.
Services we can help with
- Individual & Group Medicare Enrollment
- Medicare Revalidation Application
- Medicaid Enrollment for Group & Individual
- Insurance Contract Negotiations
- Payer Fee Schedule Creation & Evaluation
- Telemedicine Credentialing
- Lab enrollment services (CLIA)
- Medical License Application Processing & Renewals
- DEA Registration & Renewals
- CAQH Registration & Enrollment
Frequently asked questions
When can work begin?
Start dates depend on the completed proposal, required provider information, and current team capacity. Your PPS contact can confirm the schedule for your project.
How long does enrollment take?
Timing varies by payer, state, application completeness, and whether a group agreement is already in place. Your account manager can explain the expected steps and keep you updated as payers respond.
What if a payer panel is closed?
Participation is subject to each payer’s rules and panel availability. PPS can review the available options with you, which may include an appeal, waiting for the panel to reopen, or pursuing another plan. Learn more about panel closures.
What happens after enrollment?
Recredentialing, revalidations, and CAQH attestations may require ongoing attention. Ask PPS about a maintenance scope that fits your practice.
The support behind your enrollment
Credentialing involves careful applications, payer follow-up, and clear communication. Our team helps you keep those steps organized.
People you can reach
Your dedicated account manager handles questions, shares updates, and stays accountable for your project. We use technology to support the work, with people overseeing it.
Attention to the details
Payer enrollment affects when and how your practice can participate in a plan. We help manage applications and follow-up so important details are not left to chance. Learn what to consider when choosing a credentialing partner.
A service built around your practice
Needs vary by specialty, location, and payer. We tailor the scope of work to your situation and explain the next steps before you move forward.
How credentialing works
Physician credentialing is often used to define the process providers undergo to participate with insurance companies more accurately defined as provider enrollment, payer enrollment or insurance credentialing. Credentialing also means primary source verification which is performed by many credentialing companies across the country and is the process of validating that a provider meets the standards set forth by the employer or insurance company. When we mention physician credentialing, we are referring to the process providers must go through in order to see members of the various health plans. The payer must validate that the provider meets the training requirements to see their members. Once that’s complete, there must be a contract in place between the provider and payer which covers how the provider/organization will be paid for their services.
More information on the difference between provider credentialing and provider enrollment
Should You Outsource Your Credentialing and Provider Enrollment Services?
This is an excellent question and one that we answer for potential clients on a daily basis. Typically, the answer is yes, but there are always exceptions. Every practice is different and has a unique need when it comes to credentialing and contracting. Some are very complicated and in difficult markets while others are relatively simple.
Common Items We Help With:
- When you’ve outgrown your in-house department or have found it difficult to hire qualified staff
- When you are planning to start a new practice or are adding a new practice location
- When you’re joining a new practice or relocating
- When you are planning to bring in a new provider to their existing group
- When you are changing your TAX ID or Group NPI
- When carriers are requesting new or updated information
- When a provider desires to participate with an insurance plan
What defines your credentialing needs?
- We are an established organization that is currently credentialed with the plans but interested in outsourcing our department to save money and improve efficiency. Learn more about our credentialing maintenance service
- I’m opening a new practice and need to be set up with the health plans. Learn more about our practice start up services
- We’re not interested in outsourcing but have a backlog of tasks and need to get caught up. Take advantage of our temporary staffing option
Free planning resources
Credentialing checklists
Choose the checklist that fits your practice. Each one helps you gather the information needed before payer enrollment begins.
Established group checklist
Adding a provider to an established group? Use this checklist to organize the provider, practice, and payer details you will need.
Request the established group checklistNew practice checklist
Starting a new practice? Use this checklist to prepare the additional information needed for insurance credentialing and contracting.
Request the new practice checklist
Practice startup checklist
Check off the boxes and follow our timeline to ensure nothing is missed or done in the wrong order. This is completely free to any new practice. We ask for a short validation step before sending it.
Get the free checklist