Haven GroveHealthcare Consulting Services
Services

Credentialing and payer enrollment

Until a payer approves your providers and your organization, claims to that payer don't get paid. We prepare every application, submit it, follow up until it's approved, and keep the approval current afterward.

Ask about credentialing

What's included

Enrollment

  • Individual provider enrollment with commercial insurance plans
  • Group and facility enrollment, including linking providers to the group
  • Medicare enrollment through PECOS, including reassignment of benefits to your group
  • State Medicaid enrollment and managed care plan enrollment
  • Contract and fee schedule requests where the payer offers them

CAQH ProView

  • New CAQH profiles set up and completed
  • Existing profiles reviewed for gaps that stall applications
  • Re-attestation every 120 days so payers keep seeing a current profile

Changes as you grow

  • New providers added to your existing payer contracts
  • New locations, address and phone changes, and tax ID changes reported to each payer
  • NPI registry (NPPES) updates so your public record matches your applications

What we need to start

For each provider:

  • NPI number
  • State license number
  • CAQH ID, or we create the profile with you

For a group or facility, also your group NPI and tax ID.

Payers pull most supporting documents straight from CAQH, so a complete CAQH profile is the fastest way through. We tell you exactly what's missing instead of asking for everything at once.

How a credentialing project runs

  1. Readiness check

    Before anything is submitted, we confirm licenses, NPI records, CAQH and exclusion screening are clean. Most delays start with a mismatch here, so we fix it first.

  2. Payer plan

    Together we confirm which payers you need, which are open to new providers in your area, and the order to submit in. Medicare and Medicaid have their own steps and timelines.

  3. Applications submitted

    We complete and submit each application and record its tracking number, so every application has a paper trail.

  4. Follow-up until approval

    We follow up with each payer on a schedule, answer their requests for more information, and tell you when we need something from you.

  5. Approval and effective dates

    When a payer approves, we record the effective date and provider ID so your billing can start. You get a summary of where every payer stands.

Each payer sets its own timeline, and it's commonly several weeks to a few months. We can't speed up a payer's review or promise an approval, but complete applications and steady follow-up keep yours from sitting in a pile.

Credentialing maintenance

Approvals don't stay current on their own. Maintenance is a monthly service that keeps every provider and payer in good standing.

  • CAQH re-attestation on schedule
  • Re-credentialing for each payer, usually every three years
  • License, DEA, board certification and malpractice expiration tracking
  • Monthly screening against the federal exclusion lists (OIG and SAM)
  • Updates sent to payers when anything changes
  • A clear record of every provider, payer, ID and effective date

Applications already in progress?

We can take over where you left off. Tell us which payers you've applied to.

Ask about credentialing