Get Your Providers In-Network Without the Waiting Game
Every day a provider sits unenrolled is revenue you never recover. MedFactor runs payer applications, CAQH, Medicare and Medicaid enrollment, revalidation and contract maintenance end to end, so your clinicians can bill from day one.
What we take off your plate
Credentialing is not one form. It is dozens of payer-specific applications, each with its own attachments, portals and follow-up. We run the whole process and keep it running.
Start with a free review- Payer applications prepared, submitted and tracked
- CAQH ProView built, attested and kept current
- Medicare PECOS and state Medicaid enrollment
- Revalidation, recredentialing and roster accuracy
- Follow-up and escalation with every payer
- Effective dates confirmed and handed to your billing team
What a Credentialing Delay Actually Costs You
Credentialing is administrative work with a hard financial deadline attached. These are the leaks we see most often.
Revenue billed out-of-network
A provider seeing patients before enrollment clears is billing at out-of-network rates, or not billing at all. On a full schedule that is thousands per provider per month, and it is unrecoverable.
The retroactive billing window
Medicare allows retroactive billing for services furnished in the 30 days before the enrollment application is filed. Miss that filing date and those claims are gone permanently, with no appeal available.
Claims pended for missing enrollment
A provider enrolled with the group but not individually, or listed under the wrong taxonomy, produces claims that pend rather than deny, then age past timely filing while somebody investigates.
Credentialing, Enrollment and Contracting. Handled
From the first application to the revalidation five years later, one team owns the calendar.
Payer Enrollment
New applications and group additions with commercial carriers, Medicare Advantage, Medicaid managed care and workers’ compensation networks, prepared accurately the first time so there is nothing to resubmit.
CAQH ProView Management
We build the profile, load every required document, attest inside the 120-day window and answer payer data requests, so applications never stall on a lapsed attestation.
Medicare & Medicaid Enrollment
PECOS applications, 855B for the group, 855I for the individual, 855R for reassignment, plus state Medicaid enrollment, taxonomy selection and effective-date confirmation that protects retroactive billing rights.
Revalidation & Recredentialing
Medicare revalidations, state Medicaid renewals and payer recredentialing cycles tracked to the month they fall due, filed well before the deadline. An expired enrollment stops claims paying entirely.
Contract & Fee Schedule Review
We read the contract before you sign it. Fee schedules are checked against your actual CPT mix so you know which codes reimburse below market, and renegotiation happens at the next available window.
Provider Data Maintenance
Address changes, new locations, taxonomy updates, ownership changes and departing providers corrected across every payer and directory. A directory listing the wrong address is a common source of denials.
From Intake to Effective Date
A fixed sequence with one owner, so nothing sits in a payer’s queue waiting on you or on us.
Intake and document collection
We collect what payers demand up front: state licences, DEA registration, board certification, malpractice certificate naming the correct entity, CV, W-9, practice addresses and NPI details. Missing documents are the single biggest reason applications sit idle.
CAQH build and application preparation
Your CAQH ProView is completed and attested, then each payer application is built from it with the attachments that payer specifically requires. Group and individual records are aligned so taxonomy and location data match everywhere.
Submission and payer follow-up
Applications are submitted and then actively worked. We call, we check the portal, we answer every request for additional information. Applications do not progress on their own, and unworked applications are the norm in this industry.
Effective date confirmation
Once a payer approves, we confirm the effective date and provider number in writing and hand it to your billing team, so claims go out correctly from the first date of eligibility instead of being reworked months later.
Maintenance, revalidation and renewal
Revalidations, CAQH attestations, roster updates, directory corrections and recredentialing cycles are tracked on a calendar. This is the part practices lose track of, and the part that silently stops revenue.
Practices That Need Enrollment Handled
If your revenue depends on being in-network, this is the work that gets you there.
New practices
Going in-network with your first payers, from entity formation to first paid claim.
Adding providers
Every new clinician enrolled with every payer the practice already contracts with.
Multistate & telehealth
Licences, taxonomies and payer rosters managed across state lines without gaps.
Switching billers
Practices that discover, on the way out, that their enrollments were never completed.
Credentialing, Answered
The questions practice managers ask us most, answered plainly.
Commercial payers typically run 90 to 150 days from a complete submission. Medicare is often faster, and some Medicaid programmes take considerably longer because they require a separate state application and their own review. The variable that most affects the timeline is how quickly complete documentation is available, so we front-load intake rather than waiting on requests that could have been anticipated.
For each provider: state licence, DEA registration where applicable, board certification, CV, malpractice certificate naming the correct entity, and a completed CAQH profile or the information to build one. For the practice: group NPI, Tax ID and W-9, practice addresses, ownership details, and the list of payers you want to contract with. We send a single checklist and then chase what is outstanding.
Yes. That includes Medicare enrollment through PECOS using the 855B for the group, 855I for individual providers and 855R where reassignment is required, plus state Medicaid enrollment as an individual, as a group, or both, which many practices need separately from Medicare. We also confirm effective dates and provider numbers once approved, which is where retroactive billing rights get protected.
Credentialing is the payer verifying that a provider is qualified, licences, training, malpractice history, sanctions checks. Contracting is the separate step where you and the payer agree terms and a fee schedule. Both must be complete before claims pay in-network, and the fee schedule is the part practices most often leave on the payer’s default terms. We handle both and read the contract before it is signed.
Yes, and it is why a lot of practices engage us. Medicare requires revalidation at least every five years, commercial payers typically recredential every three years, and CAQH requires attestation every 120 days. Miss one and claims can stop paying with no other change in your practice. We track every provider and payer on a calendar and file ahead of the deadline.
Yes. The most common requests we get from already-credentialed practices are roster clean-up, fixing payer directories that list the wrong address or taxonomy, adding newly hired providers, expanding into another state, and reviewing existing fee schedules against actual code utilisation. If your enrollments exist but are incomplete or inaccurate, that is exactly the kind of gap that produces denials.
Find out what your enrollment is missing
Send us your current payer list and provider roster. We will review what is active, what is incomplete and what is sitting unenrolled, then tell you plainly what we would do about it.
Credentialing sits alongside medical billing, medical coding and denial management. See the specialties we serve or read how MedFactor works.