Provider Credentialing and Enrollment, Handled Quickly and Correctly
Practices launching or expanding, we manage the credentialing and insurance enrollment process with precision and speed.
Practices launching or expanding, we manage the credentialing and insurance enrollment process with precision and speed.
Grace RCM Solutions’ provider credentialing and enrollment service manages the process from the initial application through ongoing maintenance, allowing your providers to focus on patient care while we manage the administrative work.
Why Proper Credentialing Matters
For new practices, credentialing can be the biggest barrier between opening your doors and receiving insurance payments. For established practices adding providers, credentialing delays can result in:
- Weeks or monthsof treating patients without being able to bill their insurance
- Retroactive billing restrictionsthat differ by payer and can easily be overlooked
- Significant revenue lossthat can reach $20,000-$50,000+ per provider for each month of delay
- Patient access limitationswhen providers cannot participate with certain insurance plans
Credentialing can be complicated, with every payer having different forms, documentation requirements, and processing timelines. One missing document or incorrect detail can delay enrollment for weeks.
Our Enrollment & Credentialing Support
CAQH Profile Administration
CAQH ProView is a widely used credentialing database relied upon by many health plans. We manage:
- Profile setupwith accurate and complete provider information
- Document submissionincluding licenses, certifications, and insurance documents
- Quarterly attestationsto keep profiles current and active
- Re-attestation remindersto help prevent profile deactivation
Maintaining an accurate CAQH profile helps streamline enrollment with participating payers.
Medicare PECOS Registration
Medicare enrollment through the PECOS (Provider Enrollment, Chain, and Ownership System) portal comes with specific requirements:
- Individual and group enrollmentapplications (CMS-855I, CMS-855B)
- Benefit reassignmentto your group practice
- Medicare specialty changesand updates
- Revalidation supportwhen required by Medicare, typically every 5 years
Application Follow-Up
We proactively follow up with payers so applications don’t stall in a processing queue.
Re-Credentialing & Renewals
We track renewal deadlines so no provider ever falls out of network unexpectedly.
Credentialing Across Specialties
Payer requirements vary by specialty. We’ve credentialed providers across:
- Primary Care and Family Medicine
- Cardiology and Internal Medicine
- Orthopedics and Physical Therapy
- Pediatrics and OB/GYN
- Dermatology and Urgent Care
- Mental Health and Behavioral Services
Medicare generally pays only for services provided after the provider’s effective enrollment date. Unlike certain commercial payers, retroactive billing is generally unavailable. Accurate PECOS submission from the beginning is essential.
Commercial Insurance Enrollment
We coordinate enrollment with major commercial insurance payers:
- lue Cross Blue Shield(regional plans)
- UnitedHealthcare / Optum
- Aetna / CVS Health
- Cigna / Evernorth
- Humana
- State Medicaid programs
- Regional and specialty payersrelevant to your market
Each payer follows its own enrollment process and documentation standards, and our team ensures applications are prepared according to those requirements.
NPI Setup & Updates
Every healthcare provider needs a National Provider Identifier (NPI) for insurance billing. We assist with:
- Type 1 NPIregistration for individual providers
- Type 2 NPIregistration for organizations and group practices
- NPI updateswhen practice details change
- NPI deactivationwhen providers leave the organization
Standard Enrollment Timelines
|
Payer Type |
Average Timeline |
With Grace RCM Solutions |
|
Commercial payers |
90-120 days |
60-90 days |
|
Medicare (PECOS) |
65-85 days |
60-65 days |
|
Medicaid |
90-120 days |
75-90 days |
|
CAQH profile setup |
2-3 weeks |
5-7 business days |
Scope of Service
- CAQH profile setup and ongoing management
- Medicare PECOS enrollment support
- NPI registration and update assistance
- Commercial payer enrollment support
- Re-credentialing tracking and maintenance
Why Practices Trust Grace RCM Solutions
97% Clean-Claims Rate
Certified coders catch errors before submission, meaning fewer denials and faster payments.Flat Fee Pricing
No hidden costs, no setup fees, no long-term contracts. You only pay when we collect.Dedicated Account Manager
A single point of contact who knows your practice and is always reachable.HIPAA Compliant
Fully compliant data handling with regular audits and staff training to protect PHI.What Providers Say
“Grace RCM turned our billing around within months — collections are up and denials are down.”
“Their flat-fee model saves us real money and the reporting finally gives us visibility we never had.”