Provider Enrollment Services (Medicare, Medicaid & Commercial Payers)

Q: 1. How long does provider enrollment take?

Medicare (CMS-855): 30-90 days from submission to approval, depending on completeness and CMS volume. Incomplete applications or requests for additional information extend timelines by 30-60 days. Medicaid (state-specific): 45-120 days. State Medicaid programs have longer review cycles than Medicare. Some states require additional background checks or licensing verification that adds weeks. Commercial payers (Aetna, Cigna, BCBS, UHC, Humana, Anthem): 14-60 days. Smaller payers move faster; large national carriers have longer queues. Some require credentialing before enrollment approval, which adds time. Total time to billing-ready: 90-180 days across all payers, assuming no rejections or missing documents. With corrections or resubmissions, expect 180-270 days.

Q: 4. What documents are required for provider enrollment?

All providers need: Valid medical, nursing, or therapy license; DEA registration (if applicable); NPI certificate; W-9 form; malpractice insurance declaration; government-issued photo ID. Group practices also need: Articles of incorporation or LLC operating agreement; EIN verification; ownership affidavits (all owners over 20%); proof of practice location (lease or deed). State Medicaid may additionally request: Background check authorization; child support verification (state-specific); exclusion list checks (OIG, SAM); state-specific credentialing forms.

Contracting Providers manages end-to-end payer enrollment: we validate your documents, submit applications, track status, and complete go-live steps like EFT/ERA/EDI, so you get in-network faster and start getting paid sooner.

Payer Approvals Secured Nationwide

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Insurance Plans Credentialed & Contracted

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Table of Contents

Expert Oversight: This service overview was developed by CEO, Adam Nager, and reviewed for accuracy by Director of Provider Engagement, Tim Daniels

Last Updated: April 2026

Service Overview

Provider Enrollment Explained

Provider enrollment is the process of applying to Medicare, Medicaid, and commercial payers to obtain billing privileges and get paid for your services. It is a distinct step that many practices confuse with credentialing or contracting, but each serves a different purpose.

Process	What It Is	Who Handles It
Provider Enrollment	Applying to payers for billing privileges and a payer-assigned ID	CMS, state Medicaid agencies, commercial payers
Credentialing	Verifying clinical qualifications, licenses, and background	Hospitals, health plans, credentialing committees
Contracting	Negotiating and signing a fee schedule agreement	Commercial payers, managed care organizations
Revalidation	Renewing enrollment on a CMS-required cycle	CMS / Medicare Administrative Contractors

You can be credentialed without being enrolled, and enrolled without a signed contract. All three steps are typically required before you can see patients and collect payment in-network. For support beyond enrollment, visit our credentialing services and provider contracting pages.

Who This Service Is For

We work with solo providers, group practices, behavioral health organizations, DME suppliers, multi-location practices, and established practices expanding into new states. Whether you are enrolling one provider or managing a large group, Contracting Providers handles the process end-to-end.

Solo & Small Group Practices

Primary care, internal medicine, pediatrics, family medicine, specialists seeking to expand into new networks.

Behavioral Health

Therapists, counselors, psychiatrists, and psychologists enrolling in commercial plans and state Medicaid.

Therapy & Rehabilitation

Physical therapists, occupational therapists, and speech pathologists enrolling in Medicare, commercial, and Medicaid.

Multi-Location & Multi-State

Practices operating in multiple states or locations, each with separate NPI and enrollment requirements.

DME & Specialty Providers

Home health agencies, equipment companies, dental practices, and suppliers enrolling in the Medicare Supplier Program.

New Practices & Expansions

New group practices, practices opening new locations, and established practices entering new states for the first time.

Outcomes

Clients receive in-network approvals with Medicare, Medicaid, and commercial payers, along with payer-assigned billing IDs, Medicare PTANs, and state Medicaid provider IDs where applicable. We also confirm directory listings, set up EFT, ERA, and EDI for electronic billing, and provide ongoing maintenance including revalidation support and panel updates as your practice grows.

In-network approvals with Medicare, Medicaid, and commercial payers
Payer-assigned billing IDs and Medicare PTANs where applicable
State Medicaid provider IDs (state dependent)
Provider directory listing confirmation and corrections
EFT, ERA, and EDI setup for full electronic billing readiness
Ongoing maintenance including revalidation support and panel updates

PAYER ENROLLMENT

Payers We Work With

WHO WE ARE

About Contracting Providers

At Contracting Providers, our enrollment specialists help healthcare organizations simplify payer enrollment with a proactive, detail-driven approach built to reduce errors, support compliance, and keep applications moving. Enrollment is far more than paperwork; it is the foundation of your network and the catalyst for consistent revenue and practice growth

Our Difference, Your Advantage

We don’t just process paperwork. We manage your enrollment from start to finish with hands-on attention, a thorough understanding of payer requirements, and transparent communication every step of the way. Every account receives a dedicated specialist committed to accuracy, speed, and compliance, so nothing falls through the cracks.

Choosing the right enrollment partner directly affects how quickly you can obtain your billing IDs and start generating revenue. Delays, errors, and weak follow-up can lead to missed billing opportunities and unnecessary administrative setbacks. When you work with us, you get a team that stays proactive, resolves issues quickly, and keeps you informed throughout the process so you can stay focused on patient care.

Providers Credentialed Successfully

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First-Time Approval Rate

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Payer Relationships Managed

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These numbers reflect something bigger than efficiency, they reflect the trust healthcare organizations place in us every day.

**Data Disclosure: Average credentialing time (112 days) and approval rates (94% on first submission) are derived from internal aggregate performance data. These metrics are provided for informational purposes and do not constitute a performance guarantee. Certain sub-metrics are not currently tracked or included in these calculations.

THE EXPERTS

Our Enrollment Success Team

Meet the experts dedicated to solving payer complexities and securing your “Go-Live” date.

Adam Nager

Chief Executive Officer

Toni Cooper

Director Of Operations

Tim Daniels

Director Of Provider Engagement

Step-by-Step

How Our Payer Enrollment Process Works

Submission is not the finish line. From intake through go-live, we manage every step so nothing stalls, gets missed, or costs you revenue.

Which Enrollment Do You Need?

Medicare (PECOS/CMS-855): You’ll usually need PECOS access and the correct CMS-855 form (855I/855B/855S). We handle submission, follow-ups, and MAC coordination. Timeline: 30-90 days. Medicaid (state portal): Medicaid enrollment is state-specific. You’ll navigate state portals and screening steps. We handle state-specific requirements and resubmissions. Timeline: 45-120 days. Commercial payers (Aetna/BCBS/Cigna/UHC): Commercial payers rely on CAQH plus payer portals. We manage enrollment plus EFT/ERA/EDI setup so you can bill on day one. Timeline: 14-60 days.

Intake + Payer/State Targeting

Every engagement starts with a structured intake. We gather your legal entity name, tax ID, NPI, specialty, taxonomy codes, service locations, and target billing start date. From there, we help you identify and prioritize the right payers based on your state, specialty, and patient mix, including Medicare, Medicaid, Aetna, Anthem/BCBS, Cigna, UnitedHealthcare, Humana, Tricare, and any regional or managed Medicaid plans relevant to your market. This step also determines whether you need individual enrollment, group enrollment, or both.

Document Collection & Validation

Incomplete or inconsistent documentation is the most common reason enrollments get delayed. We collect your W-9, NPI confirmation, state licenses, DEA certificate, malpractice certificate, CAQH ProView profile, EIN verification, voided check for EFT, and any applicable hospital affiliations or board certifications. We review everything before submission and flag issues early, including name mismatches across your NPI, CAQH, and W-9, expired credentials, and entity structure errors that create conflicting records.

Portal + Paper Submissions

Once documents are validated, we submit through the appropriate channel for each payer. Medicare applications go through PECOS for most provider types, with paper CMS-855 forms used when required. Commercial payers are submitted through portals like Availity, One Healthcare ID, and direct payer systems. State Medicaid programs each use their own enrollment platforms, and we navigate those systems on your behalf.

Follow-Ups, Corrections, and Status Checks

Submission is not the finish line. Payers regularly request additional documentation, return correction notices, or place applications on hold. We monitor every open application, respond to payer requests promptly, and handle corrections before they cause delays. For Medicare, we track status through PECOS and escalate to your MAC when needed. For Medicaid and commercial payers, we follow up through the appropriate portals on a regular cadence. Your team receives status updates throughout so billing always knows what is pending and what is approved.

Approval, Effective Dates, and Go-Live

When an approval comes through, we confirm your effective date, payer-assigned billing ID, Medicare PTAN, and Medicaid provider ID where applicable. We then coordinate EFT so payments deposit directly to your bank, ERA so your billing team receives electronic remittance data, and EDI enrollment through your clearinghouse so claims route correctly. We also verify your directory listings across each payer before your first claim goes out, catching address errors, missing specialties, and incomplete listings before they affect patient access.

Enrollment Timeline at a Glance

Payer Type	Process Flow	Typical Timeline	Key Variables
Medicare	Intake → PECOS/CMS-855 → MAC review → Approval → EFT/ERA/EDI	30-90 days	Completeness, MAC volume, corrections needed
Medicaid	Intake → State portal → Screening → Background check → Approval → Go-live	45-120 days	State rules, licensing verification, background clearance speed
Commercial	CAQH verify → Payer portal → Credentialing review → Contracting → Go-live	14-60 days	Payer size, network demand, credentialing speed

ENROLLMENT TYPES

Payers & Networks

PECOS & Medicare Explained

PECOS, the Provider Enrollment, Chain, and Ownership System, is CMS’s online platform for submitting and managing Medicare enrollment. Individual providers, group practices, and suppliers use it to apply for billing privileges, make record updates, and complete revalidations. Ordering and referring providers who do not bill Medicare directly are also required to be registered in PECOS.

Most providers don’t interact with PECOS directly. Your enrollment partner logs in on your behalf, submits your application, monitors status, and responds to CMS requests. You still need a valid PECOS account and authorized signer credentials, but we manage the day-to-day interactions. Common mistakes we prevent include submitting under the wrong NPI, failing to link individual providers to the correct group record, leaving outdated locations in the record, and letting correspondence addresses fall out of date. See our PECOS login and status tracking guide for detailed instructions.

CMS-855 Forms: Quick Reference

Medicare enrollment usually runs through PECOS and the CMS-855 forms. The key is choosing the correct application for your situation. We confirm the right form, complete the submission, attach required documentation, and manage follow-ups with your Medicare Administrative Contractor (MAC).

CMS-855I

Individual Practitioners

Solo providers billing independently with a personal NPI and EIN. Requires license, DEA, W-9, photo ID, and malpractice attestation. Typically 30-60 days to approval.

CMS-855B

Group Practices

Group practices with two or more providers under a shared group NPI. Requires articles of incorporation, ownership affidavits, all provider licenses, and EIN verification. Typically 45-90 days.

CMS-855S

DMEPOS Suppliers & Billing Locations

Employed physicians, therapists in large clinics, and DME suppliers billing through a group structure. Approval varies: 30-75 days. Read our 855S guide.

CMS-855O

Ordering & Referring Providers

Ordering and referring providers who do not bill Medicare directly but still must be registered in PECOS. Required even if you are not submitting claims yourself.

Important Note

A solo physician who also owns a group practice may need both an 855I and an 855B depending on billing structure. Submitting the wrong form results in rejection. We match you to the correct type during intake. See our 855I vs 855B vs 855S comparison guide for detailed examples.

Medicare Revalidations

CMS requires enrolled providers to revalidate on a set cycle, typically every five years for most provider types. Missing a revalidation deadline results in deactivated billing privileges. We monitor upcoming revalidation windows and initiate the process early to protect your revenue. If billing privileges have already been deactivated, reactivation requires a full re-enrollment submission, and we handle that as well. See our Medicare revalidation checklist to understand what documentation to prepare.

Medicare Enrollment Timelines

Baseline timeline: 30-90 days from submission to approval. Processing time depends on your MAC’s current workload, provider and specialty type, application completeness, ownership structure, and whether any corrections are required. Every resubmission resets the timeline. Submitting a complete, accurate application the first time is the single most effective way to reduce delays, and that is exactly where our process is built to help.

Medicaid Provider Enrollment

Medicaid provider enrollment is state-specific. Each state has its own portal, screening requirements, and timelines. We guide you through the requirements, complete portal submissions, handle requests for corrections, and track enrollment status until approval. If you’re enrolling across multiple states, we standardize your ‘source of truth’ (NPI, addresses, entity data) to prevent conflicts that trigger delays.

State Medicaid Portals and Terms You Will See

Each state Medicaid agency uses its own enrollment system, often referred to as an MMIS (Medicaid Management Information System). You will encounter consistent terminology across most states: provider portals for application submission, taxonomy codes for provider type identification, EDI trading partner agreements for electronic claims, NPI validation steps, and state-specific enrollment packets. We work across multiple state systems and stay current on portal changes so your team does not have to learn an unfamiliar process under deadline pressure.

Common State Medicaid Portals

State	Portal / System	Use
Texas	TMHP / PEMS	Medicaid provider enrollment + maintenance
Florida	FLMMIS	Medicaid enrollment + provider updates
New York	eMedNY	Medicaid enrollment + claims
Georgia	GAMMIS	Medicaid provider enrollment and status
North Carolina	NCTracks	Medicaid enrollment + claims
New Jersey	NJ MMIS	Medicaid provider enrollment portal
Massachusetts	MassHealth	Medicaid provider enrollment + credentialing
Pennsylvania	HCSIS	Provider enrollment + claims
Ohio	OMES / ODMIS	Ohio Medicaid enrollment system
California	Medi-Cal PAVE	California Medicaid enrollment + claims

Medicaid Timelines: What to Expect

Baseline timeline: 45-120 days from submission to approval. Medicaid timelines are the most variable in provider enrollment. Some states process clean applications in weeks. Others take several months, particularly for higher-risk provider types. Common factors that extend timelines include state-required background checks, fingerprinting requirements, site verification schedules, portal backlogs, incomplete applications, and separate MCO enrollment processes that run on their own independent timelines. We set realistic expectations from the start and build your enrollment schedule around these realities.

Multi-State Note

Multi-state Medicaid enrollment compounds timelines. If you’re applying in three states, plan for 135-360 days total across all states. We coordinate across state portals to prevent one state’s delays from affecting others. Read our Medicaid enrollment by state guide for state-specific timelines and contact information.

Commercial Payer Enrollment

Total time to billing-ready: 90-180 days across all payers, assuming no rejections or missing documents. With corrections or resubmissions, expect 180-270 days.

An in-network approval is a milestone, but it does not mean you are ready to bill. Before your first claim goes out, three setup steps need to be completed.

EDI enrollment establishes the electronic connection between your practice management system and each payer through your clearinghouse. Without it, claims cannot transmit.
ERA enrollment delivers digital remittance data directly to your billing system, eliminating manual payment posting from paper EOBs.
EFT enrollment sets up direct deposit of insurance payments so you are not waiting on paper checks to clear.

We coordinate all three alongside your clearinghouse and confirm that payer IDs are mapped correctly before live billing begins. These steps are part of our enrollment engagement, not an afterthought. Read our comprehensive guide on EFT/ERA/EDI setup to understand what to expect and when.

Network Participation and Directory Listing Verification

Once enrollment is active, we verify that your information appears correctly in each payer’s provider directory. Inaccurate listings mean patients may not find you, or may assume you are out-of-network and go elsewhere. We confirm that your name, credentials, specialty, address, and service location are accurate, and that both group and individual listings are present where applicable. Common issues we catch include providers listed under the wrong specialty, outdated addresses, and new providers not appearing in the directory despite an approved enrollment. We request corrections and follow up until every listing is confirmed.

NATIONWIDE REACH

Coverage Areas

We serve providers nationwide across 40+ states through a fully remote enrollment process built for speed and consistency. Our team also understands local payer requirements and state-specific nuances that can affect timelines, documentation, and approvals.

Virginia

California

Florida

Maryland

Arizona

Tracking Approvals

Enrollment Status Checks

Enrollment status tells you where your application stands in a payer’s approval process. Understanding status codes and timelines prevents confusion and keeps you informed at every stage.

Medicare (PECOS) Statuses

Application received - Your CMS-855 form arrived and is under review.
Additional info requested - CMS needs clarification or missing documents before proceeding.
Pending - Your application is in queue for final review.
Approved - You’re in-network and effective as of a specific date.
Rejected - Application was denied; you’ll receive a reason and can reapply.

Medicaid Statuses

Submitted - Application is in the state portal.
Under review - State is verifying credentials, licensing, and compliance.
Conditional approval - Approved pending final documentation or background clearance.
Active - You’re enrolled and can bill.
Terminated - Enrollment ended; reapplication may be required.

Commercial Payer Statuses

In progress - Application submitted and pending underwriting.
Additional info needed - Payer is requesting documents or clarifications.
Approved - Network acceptance confirmed; effective date assigned.
Contracted - You’re live and can submit claims.
Denied - Application rejected; appeal options may apply.

Important Distinction

Status doesn’t mean you’re ready to bill. Approval plus EFT/ERA/EDI setup plus directory verification equals billing readiness. Many providers miss this distinction and lose revenue waiting for claims to process.

What You Can Do If You're Stuck

If your application stalls or you receive a status of “additional information requested,” don’t wait passively.

Log into the payer portal. Check for uploaded messages, missing attachments, or form errors you can correct yourself.
Identify the specific request. Payers usually list exactly what’s missing (e.g., “NPI verification letter,” “updated W-9,” “ownership documentation”).
Gather and submit corrected documents. Resubmit within the payer’s stated deadline, usually 30 days.
Follow up in writing. Email the payer’s provider enrollment team with your application reference number and confirmation of resubmission. Keep a record.

If status hasn’t changed in 60+ days, call the payer’s provider relations department, request an enrollment coordinator by name, ask for a timeline for final decision, and document the date, time, and name of the person you spoke with.

Phone Numbers & Contacts

Rather than listing every payer’s enrollment line here (which changes frequently), use your payer’s provider portal to find current contact information. Most have a “provider relations” or “enrollment support” section with phone numbers and email addresses.

For Medicare: Call CMS at 1-866-783-7986 or log into PECOS directly at pecos.cms.hhs.gov to check your status.

If tracking becomes overwhelming, this is exactly where enrollment partners step in. We monitor your status across all payers, escalate holds and rejections, and resubmit corrections so you don’t have to juggle multiple portals and phone numbers. Book a free consultation to discuss how we keep your enrollments on track.

Avoid These Pitfalls

Common Provider Enrollment Mistakes

Payers cross-check your application against multiple databases. If your business name, address, ownership structure, or tax ID doesn’t match across CAQH, PECOS, NPI Registry, and IRS records, your application stalls or gets rejected. You might list your practice as “Smith Primary Care” on PECOS but “Smith, Jane MD LLC” on your W-9 and “Jane Smith MD” in CAQH. Payers flag inconsistencies as potential fraud risk and ask for clarification. This adds weeks to your timeline.

The single source of truth concept: Before submitting to any payer, establish one authoritative version of your legal business name, physical address, TIN, NPI, ownership names and percentages, and billing and service location addresses. Cross-check CAQH, NPI Registry, and IRS records before filling out CMS-855 or payer applications. Correct any existing mismatches in CAQH first; changes propagate to many payers automatically. Read our detailed guide on CAQH best practices for credential management to ensure consistency from the start.

Missing CMS-855 Attachments or Signatures

CMS-855 forms require specific supporting documents. Missing or unsigned pages are the number one reason Medicare enrollment gets rejected. Required attachments vary by form type and include medical licenses, DEA certificates, malpractice insurance declarations, W-9 forms, EIN verification, photo ID, and articles of incorporation for group practices. Common rejection causes include missing signatures on attestation pages, illegible photocopies, expired licenses or DEA, and W-9 not matching legal name or EIN.

Entity Structure Confusion

Selecting the wrong entity type on your CMS-855 or payer application leads to rejection or approval under the wrong structure, complicating billing and credentialing later.

Individual (855I)

Solo provider with a personal NPI, no group affiliation. You’re billing under your name and TIN.

Group (855B)

Two or more providers under one business entity, group NPI, shared TIN. Each provider has an individual NPI within the group.

Billing Location (855S)

Individual provider employed by or contracted with a group. You have your own NPI but submit claims under the group’s structure.

How to Determine Your Type

Check your existing Medicare or commercial credentialing paperwork. When in doubt, we match you to the correct type during intake.

Forgetting EFT/ERA/EDI

Approval doesn’t mean you’re ready to bill. Many providers get approved for Medicare or commercial networks, then wait weeks for claims to process because they haven’t set up EFT (Electronic Funds Transfer), ERA (Electronic Remittance Advice), and EDI (Electronic Data Interchange). Without EDI, you can’t submit claims electronically. Without EFT/ERA, you’re stuck requesting paper checks and manually tracking payments. This delays cash flow by 30+ days and creates reconciliation headaches. Read our comprehensive guide on EFT/ERA/EDI setup to understand what to expect and when.

PROVEN RESULTS

Case Studies

Case Study 1

Solo Physical Therapist, 2 States

Challenge:Confused about 855I vs 855S while expanding from New York to New Jersey; unclear on New Jersey Medicaid requirements.

Solution:We identified 855I for NY Medicare, coordinated NJ Medicaid through NJ MMIS portal, and enrolled in 3 commercial payers per state.

Result:All enrollments approved in 8 weeks; ready to bill across both states.

Case Study 2

Behavioral Health Group, 5 States

Challenge:Growing therapy practice with 8 clinicians across TX, FL, GA, NC, CA. Entity structure confusion, inconsistent CAQH data, missed revalidation deadline in Texas.

Solution:Standardized entity info, updated CAQH across all locations, filed emergency Medicare revalidation in TX, and coordinated multi-state Medicaid enrollments.

Result:All clinicians in-network within 12 weeks; no billing interruptions.

Case Study 3

DME Supplier, Medicare + 2 Medicaid States

Challenge:Home health agency new to Medicare enrollment. Supplier-specific PECOS requirements unclear; missing CMS-855S documentation.

Solution:Guided 855S completion, coordinated with DME MAC, activated supplier-specific EDI, managed Texas + Florida Medicaid enrollment.

Result:Medicare supplier number issued in 6 weeks; Medicaid in both states within 10 weeks.

Toni is totally awesome. We had trouble getting credentialed with some insurance companies and she worked her magic and got them done. I would highly recommend her!

We are a new Medical Weight-loss Program that contracts with Contracting Providers, LLC to assist us with credentialling, provider enrollment, and billing. They do a great job providing support and guidance in our efforts to manage all of our patient's insurance needs. The staff are outstanding, and I am very happy to have them as my provider.

We’ve been using Contracting Providers to support our medical billing company since 2018 and have enjoyed the relationship. Understanding that provider enrollment, Credentialing, and rate negotiation takes time and in many times out of the control of the people or company that is performing the work has allowed our firm to build a trusting relationship with the team at Contracting Providers…

Credentialing our providers with insurance payers has been a smooth process once we handed it to Contracting Providers almost 2 years ago. They work fast, are quick to communicate and keep us updated while the processes are running. Pricing is adequate and billing does not bring any surprises.

FAQs

Frequently Asked Questions

1. How long does provider enrollment take?

Total time to billing-ready: 90-180 days across all payers, assuming no rejections or missing documents. With corrections or resubmissions, expect 180-270 days.

2. Do I need PECOS to enroll in Medicare?

Yes. PECOS (Provider Enrollment, Chains, and Ownership System) is the mandatory system for Medicare enrollment. You must create a PECOS account, submit your CMS-855 form through PECOS, and track your status in PECOS.

However, most providers don't interact with PECOS directly. Your enrollment partner logs into PECOS on your behalf, submits your application, monitors your status, and responds to CMS requests. You still need a valid PECOS account and authorized signer credentials, but the day-to-day management is handled.

3. What is CMS 855 and which form do I need?

The CMS-855 is the official Medicare Provider Enrollment Application. CMS requires it to add you to Medicare and assign you a provider number. The form has three main versions depending on your practice structure:

CMS-855I: Individual provider (solo practitioner with personal NPI and EIN).
CMS-855B: Group practice (two or more providers, shared group NPI, group EIN).
CMS-855S: Individual provider within a group (you have your own NPI but bill through a larger practice structure).

Submitting the wrong form gets your application rejected. We match you to the correct CMS-855 type during intake based on your business structure.

4. What documents are required for provider enrollment?

All providers need: Valid medical, nursing, or therapy license; DEA registration (if applicable); NPI certificate; W-9 form; malpractice insurance declaration; government-issued photo ID.

Group practices also need: Articles of incorporation or LLC operating agreement; EIN verification; ownership affidavits (all owners over 20%); proof of practice location (lease or deed).

State Medicaid may additionally request: Background check authorization; child support verification (state-specific); exclusion list checks (OIG, SAM); state-specific credentialing forms.

5. Can you enroll me in multiple states?

Yes. If you're licensed and credentialed in multiple states, we enroll you in Medicare, Medicaid, and commercial payers across all of them.

Each state has its own Medicaid program with separate enrollment requirements. Medicare enrollment is national once approved, but you designate practice locations by state in your PECOS profile. Commercial payers operate differently in each state, so you'll need separate network applications with each insurer in each state.

6. What is CAQH and do I need it?

CAQH (Council for Affordable Quality Healthcare) is a credential registry that most payers, Medicare, and Medicaid use to verify your licenses, DEA, NPI, and malpractice history. It's not technically required, but most payers reference it automatically, and keeping it current speeds enrollment across all payers.

CAQH is free to create and maintain. Once you build your profile, updating it in CAQH often automatically updates your data with connected payers.

7. Is revalidation the same as re-enrollment?

No. Revalidation is a renewal process (Medicare does this every 5 years) where you confirm your existing information is still accurate. Re-enrollment would be applying as new, for example if you're adding a new location or changing entity structure.

We track your revalidation due dates and manage the process to avoid billing interruptions.

Related Resources

📘

Why Healthcare Practices Outsource Payer Enrollment

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Avoiding Delays in Medicare Provider Enrollment: What You Need To Know

📘

What a Payer Enrollment Specialist Does & Why Your Practice Needs One

Book Your Free Consultation

Provider enrollment doesn’t have to be a DIY headache or a months-long stall. On a free 45-minute consultation call, we’ll review your current enrollment status, identify which payers you need to target, highlight any gaps or risks in your existing credentialing, and outline a clear next step.