What our credentialing services include
Fastora’s credentialing services take a clinician from first consultation to being enrolled with payers and ready to bill. We handle payer enrollment services for Medicare, Medicaid and commercial plans, keep CAQH profiles current and track re-credentialing dates so enrollment does not lapse.
Our provider credentialing services cover new practices, new providers joining a group and groups adding a location or a new license type. That includes physician credentialing services for MDs and DOs, nurse practitioner credentialing services, and enrollment for psychologists, therapists, counselors and rehab clinicians.
- Individual and group setup: NPI Type 1 and Type 2 records, taxonomy codes and practice locations checked so they match across payers.
- Provider enrollment services: Medicare, state Medicaid and commercial applications prepared, submitted and followed up.
- CAQH credentialing: profiles built, documents uploaded, payers authorized and attestations kept current.
- Payment setup: EFT and ERA enrollment so payments and remittances arrive electronically.
- Maintenance: re-credentialing, revalidation and change-of-information updates when a license, address or group changes.
Credentialing and billing sit with the same company, so the effective dates and provider IDs we secure go straight into the billing workflow. That handoff is where many practices lose claims: the provider is approved, but billing does not know it yet. Practices that want both from one team can see the rest of our medical billing services.
Our credentialing process and timeline
Every application follows the same tracked process, so you always know which stage each provider and payer is in.
- Consultation: provider types, locations, payers and start dates.
- Document collection: licenses, certifications, malpractice coverage, work history and identification.
- State licensing: coordination with the state board where a license is new or changing.
- NPI & CAQH setup: individual and group NPIs confirmed and the CAQH profile completed.
- Payer applications: Medicare, Medicaid and commercial applications prepared.
- Panel submissions: applications submitted to each payer’s network.
- Follow-ups: regular status checks and quick responses to payer requests.
- Final approval: effective dates, provider IDs and contracts recorded.
- Ready to bill: enrollment details handed to billing.
Payer processing times vary widely and are outside anyone’s control, which is why steady follow-up matters more than the initial submission. The timeline depends mostly on the payer, the provider’s license type, whether a state license or NPI is new, and how complete the application is on the first pass.
We do not quote a fixed timeline. Instead, every provider and payer has a tracked status and a next action date, and you can see where each application stands. Our article on how long credentialing takes explains what slows applications down and what you can prepare in advance.
Medicare, Medicaid and commercial payers
Payer enrollment is different for each program, and one approval does not carry over to another plan, even from the same parent company. We track each payer separately.
NPI and taxonomy
Every provider needs an individual (Type 1) NPI, and a group or clinic that bills under its own name needs an organizational (Type 2) NPI. The taxonomy codes on each NPI record describe the provider type and specialty, and a mismatch between NPPES, the payer file and the claim is a common cause of enrollment delays and claim rejections.
PECOS and the CMS-855I
Medicare enrollment is completed online through PECOS, the Provider Enrollment, Chain and Ownership System, or on paper CMS-855 forms, and is processed by the Medicare Administrative Contractor for your region. Individual practitioners enroll on the CMS-855I, clinics and group practices on the CMS-855B, and individuals who bill through a group also reassign their benefits to that group.
Texas Medicaid (TMHP) enrollment
Medicaid enrollment is run by each state, and state programs generally require providers to enroll with the state even when patients are covered through Medicaid managed care plans, which credential separately. In Texas, providers enroll and revalidate with Texas Medicaid through TMHP’s Provider Enrollment and Management System (PEMS), then join the managed care organizations they want to see patients through.
Commercial panels
Commercial panels each have their own applications, network decisions and contracts, and some panels may be closed to new providers in a given area. Many rely on CAQH data rather than their own forms, and contracts arrive with a fee schedule we review before signing.
EFT and ERA setup
Approval is not the last step. Electronic funds transfer (Medicare uses the CMS-588 form) and electronic remittance advice enrollment must be set up with each payer, so payments arrive in the right account and remittances can be posted electronically.
CAQH setup and attestation
Many commercial payers pull provider data from CAQH ProView rather than asking for it on each application. An incomplete or out-of-date profile can hold up several applications at once, so CAQH credentialing is usually the first task after documents are collected.
Our CAQH management covers building the profile, uploading current documents, authorizing the right payers to view it and re-attesting on the recurring schedule CAQH requires, commonly every 120 days. When a license, malpractice policy or practice address changes, we update the profile so payers see current information.
Credentialing for behavioral health and therapy providers
Behavioral health credentialing covers a wide range of license types: psychiatrists, psychologists, licensed clinical social workers (LCSWs), licensed professional counselors and mental health counselors (LPCs and LMHCs), and marriage and family therapists (MFTs). Each payer lists which license types it accepts, and some route behavioral health to a separate carve-out plan with its own enrollment.
Medicare changed significantly for counselors and family therapists. According to CMS, starting January 1, 2024, marriage and family therapists and mental health counselors can enroll in Medicare and bill for their services; the mental health counselor category includes licensed professional counselors and certain addiction and drug and alcohol counselors who meet the requirements.
Our guide to mental health credentialing explains the steps in detail, and our billing team works with therapists and counselors and psychiatry practices once enrollment is complete.
Insurance credentialing for therapists in rehab settings
Insurance credentialing for therapists in rehab settings has its own details. Medicare enrolls physical therapists, occupational therapists and speech-language pathologists in private practice as their own provider types, separate from therapists who bill through a physician group or facility.
Commercial plans may credential therapists individually or through the clinic, and some route therapy benefits through a separate network manager. We confirm each plan’s approach before applying and hand the results to billing for physical therapy, occupational therapy and speech therapy practices. We also handle dental credentialing services for dental practices enrolling with commercial and government payers.
Maintenance: CAQH re-attestation and revalidation
Enrollment is not a one-time task. Commercial payers re-credential providers on a recurring cycle, and Medicare requires enrolled providers to revalidate their enrollment periodically, generally every five years for most providers and suppliers, when their contractor sends notice.
We track re-credentialing and revalidation dates for each provider and payer, respond to requests before deadlines and keep supporting documents current. Missing a revalidation can lead to deactivation of billing privileges, which stops payment until it is fixed.
Texas Medicaid also requires providers to revalidate their enrollment periodically through PEMS, and managed care plans and commercial payers send their own re-credentialing requests. One calendar of due dates per provider is the simplest way to keep every enrollment active.
Outsourced credentialing services and pricing
Practices choose outsourced credentialing services when enrollment competes with patient care for the same staff time, or when a group adds several providers at once. A credentialing company for providers should show you a status for every application, follow up on a schedule and keep documents current after approval.
Fastora quotes after a free assessment, based on the number of providers, payers and locations, and whether credentialing is combined with billing. There are no hidden setup fees for our medical credentialing services. Our pricing models page explains how scope affects a quote, and our article on credentialing costs covers what drives the cost of insurance credentialing services in general.
Credentialing and billing services from one team also remove a common gap: the billing side knows each provider’s effective dates and IDs on the day they are issued.
Why billing waits for enrollment
A claim billed under a provider who is not yet enrolled with the payer is usually denied. Some payers allow a limited retroactive effective date; many do not, and services before approval may not be billable to the plan at all.
That is why the last stage of our process is “ready to bill”, not “approved”. Before a new provider’s claims go out, billing confirms the effective date, provider ID and network status for each payer, and eligibility checks confirm the patient’s plan is one where the provider is in network.
Medical billing and credentialing services work best together because the same team checks both sides. For a step-by-step overview you can share with new providers, see our provider credentialing guide.
Insurance paneling for therapists and counselors
Therapists joining payer networks may hear the same work called insurance paneling, therapist credentialing or mental health credentialing. It is the enrollment process described above, with extra attention to license type, CAQH profile accuracy and whether a panel is open to your specialty in your area.
Our step-by-step guide to getting on insurance panels as a therapist covers panel research, application order and what to do while applications are pending.
When Credentialing Stalls: Our Escalation Process
Credentialing applications stall more often than payers admit. An application sits in a queue, a document goes missing, or a reviewer requests information that was already submitted. Without a defined escalation process, these delays turn into months of lost revenue while the practice waits for someone to act. Our process treats a stalled application as a problem to solve, not a status to accept.
It starts with proof. Every submission is documented with its date, method, and confirmation — portal submission receipts, fax confirmations, or certified mail tracking. When a payer claims they never received something, we do not resubmit blindly; we reference the original submission and ask the payer to locate it. This single step resolves a surprising number of “lost” applications, because it shifts the conversation from starting over to finding what already exists.
Follow-up runs on a set cadence, not on hope. We check application status at defined intervals and log every contact: who we spoke with, what they said, and the next step. If the standard channel produces no movement, we escalate to the payer’s provider relations team with the full contact history attached — documented persistence gets results where vague complaints do not.
We also track what happens after approval. Medicare revalidation, CAQH re-attestation, and payer re-credentialing all carry their own deadlines, and missing one can deactivate a fully credentialed provider. Our tracking keeps every enrollment current so a lapse in paperwork never becomes a gap in billing privileges.
Medicare Revalidation Tracking
Medicare requires enrolled providers and suppliers to revalidate their enrollment information on a regular cycle — generally every five years. When your revalidation due date arrives, your Medicare Administrative Contractor sends a notice, and you must submit a complete revalidation application by the deadline in that letter. Missing it is not a minor oversight: CMS can deactivate your billing privileges, which stops Medicare payments and requires a new enrollment application to restore.
Off-cycle revalidation can also be triggered outside the five-year rhythm. A change of ownership, a new practice location, a reported change in adverse legal actions, or a direct CMS request can all require revalidation ahead of schedule. Practices that expand, relocate, or restructure are the most likely to face an unexpected revalidation notice.
Our tracking keeps every provider’s revalidation date on record and watches for the notices that start the clock. When a due date approaches or an off-cycle trigger occurs, we prepare the revalidation application with current, verified information — so the enrollment stays active and billing never skips a beat.
Looking for therapist credentialing services or mental health credentialing services? It is the same enrollment process described on this page — CAQH profile setup and attestation, NPI registration, applications to each payer panel, scheduled follow-up and revalidation tracking — with extra attention to license type and whether a behavioral health carve-out runs its own panel. Payer enrollment is handled start to finish: documents are collected once, every application is tracked, and you are told when each provider can bill. See our mental health credentialing guide and insurance paneling for therapists.
Dental practices follow a separate enrollment track from medical payers: our dental credentialing services handle plan-by-plan applications, contracts, and effective dates for dentists and dental groups.
The credentialing process for providers, handled start to finish
The credentialing process for providers has more moving parts than most practices expect: the individual NPI, a completed CAQH profile, state licensure verification, Medicare and Medicaid enrollment, and a separate application to each commercial panel. Our healthcare credentialing services run all of it in one workflow — payer enrollment services that start with NPI registration services and CAQH setup and end with confirmed effective dates you can bill under. That includes medicare credentialing through PECOS as well as full medicare enrollment services for providers, not just the commercial panels.
The CAQH credentialing process is usually the part providers feel most: re-attestation every 120 days, supporting documents kept current, and each payer pulling from the same profile. Our CAQH credentialing services keep the profile attested and complete so applications do not stall on a missing document. Our provider credentialing guide walks through each step.
Credentialing for physicians, PAs, counselors and telehealth
As a physician credentialing company, we enroll physicians, and we do the same work for the rest of the care team: physician assistant credentialing, counselor credentialing for LPCs, LMFTs and LCSWs, and credentialing services for behavioral health practices that mix license types. For virtual practices, telehealth credentialing adds a layer — providers who see patients across state lines need multi-state credentialing for telehealth, with licenses and enrollments lined up in each state. Providers looking for credentialing services Texas practices can rely on get the same tracked process for Texas Medicaid and the major Texas commercial plans.
Aetna credentialing services are one of the most requested enrollments we handle, including the behavioral health carve-out where it applies. If you are searching for an insurance paneling company rather than a general biller, that is exactly what this service is: panels only, tracked to completion. Related reading: mental health credentialing guide, insurance paneling for therapists.
Outsourcing credentialing — and keeping enrollment current
Most practices that outsource credentialing do it because follow-up is relentless: every application needs calls at the right intervals. A team that handles outsource medical credentialing full-time keeps a call calendar, documents every touch and escalates when a payer goes quiet. When you compare the best medical credentialing companies, ask who makes the follow-up calls and how you see the status — that is where enrollments stall. As credentialing companies for providers go, the difference is rarely the forms; it is the tracking.
Enrollment does not end at approval. Credentialing maintenance means re-attesting CAQH, answering payer recredentialing requests and keeping licenses and malpractice documents current. Our recredentialing services track each payer cycle and re-attest before deadlines, and our revalidation services handle the Medicare revalidation notices that arrive on their own schedule. Choosing a recredentialing company comes down to one thing: whether every renewal date sits on a calendar someone watches. For credentialing for new practices, the order matters — NPI and CAQH first, then Medicare, then commercial panels — because the slowest payer sets your opening date. See how long credentialing takes for the realistic timeline.
Can I bill insurance before credentialing is complete?
Usually no. Most payers pay only for dates of service on or after your effective date, which is why enrollment should start before your first patient day. A few payers backdate effective dates; never assume it. We confirm each effective date in writing before you bill.
What is an NPI number?
The National Provider Identifier is the unique 10-digit number that identifies a provider or organization to every payer. Individual clinicians use a Type 1 NPI; practices and groups use a Type 2. Most enrollments need both, and the number stays with you for your career.