How Much Does Credentialing Cost?

How much does credentialing cost a practice?

How much does credentialing cost? The direct fees are usually small, and for many individual clinicians some core steps are free. The real cost is the staff time needed to complete and follow up on applications, any vendor fees, and the revenue a practice cannot collect while a provider waits to be approved.

Because those costs depend on how many providers, payers and locations you have, the useful approach is to build your own estimate. This article lists each cost item, explains the pricing models vendors use and shows how to compare options.

Fees charged by government programs and registries

Several of the core steps cost nothing in direct fees. Others carry a fee only for certain provider types, so check the current rules for your own enrollment.

Item	Direct fee?	Notes
NPI from NPPES	No	CMS issues Type 1 and Type 2 NPIs free of charge
CAQH ProView profile	No fee to providers	Participating health plans fund the platform
Medicare enrollment (CMS-855I)	Generally none for physicians and non-physician practitioners	Individual practitioners are generally exempt from the Medicare application fee
Medicare enrollment for institutional providers	Yes	CMS sets the application fee each calendar year and publishes it in the Federal Register
State Medicaid enrollment	Depends on state and provider type	States may charge an application fee to institutional providers; check your state Medicaid agency
Commercial plan applications	Usually none	Most plans do not charge providers to apply

Licenses, DEA registration, board certification and malpractice coverage also cost money, but they are costs of practicing rather than of credentialing itself. Include them in your budget if a new provider needs them before applications can go out.

Staff time: the largest in-house cost

Doing credentialing in-house means paying for the hours it takes. Each payer application needs data entry, document uploads, signatures, follow-up calls, answers to information requests and contract review. Multiply that by the number of providers and payers, then add CAQH re-attestations, Medicare revalidation and recredentialing cycles.

To estimate the cost, track how long one complete application takes your team from start to approval, including follow-up. Multiply by your loaded hourly staff cost and by the number of applications you expect this year. Add time for ongoing maintenance on every enrolled provider.

Questions that change the estimate

• How many providers will join, leave or change locations this year?
• How many payers does each provider need, including Medicaid managed care and Medicare Advantage plans?
• Does each new location or tax ID trigger new applications?
• Who on staff already knows PECOS, CAQH and each payer portal?

The cost of waiting

The cost many practices overlook is lost or delayed revenue. While a provider is not yet active with a payer, claims are usually denied, and many commercial plans do not pay for services before their effective date. A provider who is ready to see patients but cannot bill most of them is a fixed cost with little income.

A simple way to estimate it: take the visits a provider would see per week with a given payer, multiply by your average payment for those visits, and multiply by the weeks of delay. Run it for each major payer. This number often matters more than any application fee, and it is why a complete first submission is worth the effort. The article on credentialing timelines covers where delays usually come from.

Costs that come from credentialing errors

Mistakes in enrollment data create costs long after approval. A provider loaded under the wrong tax ID, location or taxonomy can see claims rejected or paid to the wrong entity. A lapsed CAQH attestation or a missed Medicare revalidation can interrupt payment for every patient that provider sees.

• Denied claims that must be corrected and resubmitted, sometimes past the timely filing limit.
• Payments sent to an old group or bank account after a provider changes practices.
• Gaps in coverage when a revalidation or recredentialing request goes unanswered.
• Extra staff time spent tracing why a payer does not show the provider as active.

Count these in your estimate, because they are part of the cost of doing credentialing with too little time or tracking.

Credentialing services cost: common pricing models

Credentialing services cost different amounts depending on how the vendor prices the work and what is included. Industry pricing varies widely by region, provider type and scope, so compare quotes on the same list of payers and tasks.

Pricing model	How it works	Watch for
Per application or per payer	A fee for each payer application per provider	Whether follow-up, contract review and resubmissions are included
Per provider package	A set fee to credential one provider with an agreed list of payers	Which payers are in the package and what extra payers cost
Monthly maintenance	A recurring fee per provider for CAQH upkeep, revalidation and recredentialing	Whether license and document expiry tracking is included
Bundled with billing	Credentialing included as part of a medical billing agreement	Which credentialing tasks are covered and for how many providers

When credentialing is bundled with billing, look at the whole agreement rather than the credentialing line alone. Our article on what medical billing services cost explains how billing pricing models compare.

How to compare credentialing quotes

A lower price is not cheaper if it leaves tasks to your staff or leads to longer delays. Ask each vendor the same questions and put the answers side by side.

1. Which payers, programs and forms are included (PECOS, CMS-855B, Medicaid, managed care, commercial, Medicare Advantage)?
2. Is CAQH setup and re-attestation included?
3. Is EFT and ERA enrollment included for each payer?
4. How are follow-ups handled, and how often will you receive status updates?
5. Are contract and fee schedule review part of the service?
6. What happens if a panel is closed or an application is denied?
7. Are revalidation and recredentialing included or billed separately?
8. Who owns the provider data and documents if you end the agreement?

In-house or outsourced: a quick comparison

Factor	In-house	Outsourced
Direct cost	Staff wages and time	Vendor fees
Expertise	Depends on staff experience with each payer and portal	Depends on the vendor's experience with your specialty and state
Tracking	Your own spreadsheet or software	Vendor tracking and reports
Control	Full, with direct payer contact	Shared; you need regular status reports
Best fit	Stable groups with few new hires and an experienced coordinator	Growing groups, new practices and practices without a dedicated coordinator

For the full set of steps either team must complete, see the provider credentialing guide.

Getting a quote for credentialing

Fastora quotes its credentialing and payer enrollment work after a free assessment, with no hidden setup fees, and pricing depends on the number of providers, payers and locations. You can start with a free billing assessment to see how enrollment gaps are affecting your claims.

Frequently asked questions