Credentialing & Enrollment Services
Get Credentialed. Get Paid. Stay Compliant...
MSM Consulting provides complete credentialing and enrollment solutions for healthcare providers, agencies, and organizations across all 50 states. Our specialists manage the entire payer enrollment lifecycle — from application preparation and documentation verification to payer approval, follow-up, and ongoing compliance monitoring.
With more than 18 years of experience, we help healthcare organizations reduce administrative delays, prevent enrollment gaps and maintain access to Medicare, Medicaid and commercial payer networks.
Why Healthcare Organizations Choose MSM Consulting
- 18+ years of credentialing expertise
- Nationwide support across all 50 states
- 100+ payer networks supported
- Bi-weekly application follow-ups
- Complete credentialing and enrollment management
- Medicare Enrollment
- Medicaid Enrollment
- Commercial Payer Networks
- CAQH Profile Management
- Contract Negotiation
- Re-Credentialing & Monitoring
- Out-of-Network Enrollment
Understanding the Basics
What Is Provider Credentialing & Enrollment?
Provider credentialing services are the process of verifying a healthcare provider’s qualifications — including licenses, education, training, certifications, and work history — against the standards required by insurance payers, hospitals, and accreditation organizations.
Enrollment is the separate administrative step of formally adding that credentialed provider to a specific insurance payer’s network so they can submit claims and receive reimbursement.
Many healthcare organizations lose thousands of dollars every month when this process stalls due to incomplete applications, missing documentation, credentialing delays, or expired enrollments.
MSM Consulting manages both processes from beginning to end, helping providers establish payer relationships, maintain compliance, and avoid unnecessary revenue interruptions.
The Real Cost of Poor Credentialing
- Credentialing mistakes can create serious financial and operational challenges:
- Delayed payments: Claims may be rejected or remain unpaid until enrollment issues are resolved.
- Revenue gaps: Providers cannot bill certain payers during inactive enrollment periods.
- Compliance concerns: Expired credentials may create regulatory risks.
- Network termination: Missed re-credentialing deadlines can result in removal from payer networks.
- Longer approval timelines: Incorrect applications often require additional reviews and corrections.
Losing Revenue to Credentialing Delays?
Tell us your situation. We’ll identify the bottleneck and get your enrollment back on track — fast.
Understanding Credentialing & Enrollment Terms
What Is Credentialing?
Credentialing is the verification process used to confirm that a healthcare provider meets professional standards required by insurance companies, hospitals, and healthcare organizations.
The process typically reviews:
- Medical licenses
- Education and training
- Board certifications
- Work history
- Malpractice insurance
- DEA registration
- Professional references
Credentialing is the verification process used to confirm that a healthcare provider meets professional standards required by insurance companies, hospitals, and healthcare organizations.
What Is Enrollment?
Enrollment is the process of adding an approved healthcare provider to an insurance payer’s network.
After enrollment is completed, providers can:
- Submit claims
- Receive insurance reimbursements
- Treat covered patients
- Participate in contracted payer networks
MSM Consulting provides provider enrollment services for Medicare, Medicaid, commercial insurers, and specialty payer programs.
What Is Re-Credentialing?
Re-credentialing is the renewal process required by insurance companies to confirm that providers continue meeting participation requirements.
2–3Years
Most payers require re-credentialing every two to three years.
MSM Consulting tracks renewal deadlines, prepares required documentation, and starts the renewal process early to prevent credential expiration and billing interruptions.
What Is CAQH ProView?
CAQH ProView is a centralized database used by many commercial payers to collect and verify healthcare provider information.
A complete CAQH profile includes:
- Provider demographics
- Education history
- Licenses
- Certifications
- Practice locations
- Malpractice information
MSM Consulting creates, updates, and maintains CAQH profiles to ensure payer applications contain accurate information.
Our Services
Complete Credentialing & Enrollment Solutions
Healthcare institutions require more than just submitting applications. They require experts who know regulations for payers, the requirements for documentation and timelines for approval.
Our medical credentialing services help providers complete enrollment efficiently while reducing administrative workload.
Provider Credentialing Applications
- We prepare, review, and submit credentialing applications for:
- Individual providers
- Physician groups
- Healthcare agencies
- Specialty organizations
- Every application is reviewed for accuracy, completeness and payer-specific requirements before submission.
Ongoing Credential Monitoring
- We continuously monitor:
- License expiration dates
- DEA renewals
- Board certifications
- Malpractice coverage
- Compliance requirements
- Our proactive approach helps organizations avoid unexpected credentialing issues.
Medicare & Medicaid Enrollment
Under medical billing and credentialing services, MSM Consulting manages Medicare enrollment through PECOS and assists with Medicaid enrollment across all 50 states.
- Services include:
- NPI verification
- Taxonomy review
- Billing information setup
- State Medicaid applications
- Documentation management
Commercial Payer Network Enrollment
- We help providers enroll with major commercial insurance companies, including:
- UnitedHealthcare
- BlueCross BlueShield
- Aetna
- Cigna
- Humana
- Specialty and regional payers
- Our insurance credentialing specialists understand payer-specific requirements and help organizations build stronger reimbursement networks.
Payer Network Research & Strategy
- Choosing the right payer networks can directly impact revenue and patient access. We analyze:
- Specialty type
- Geographic market
- Patient demographics
- Service offerings
- Reimbursement opportunities
- Our team helps organizations prioritize payer relationships that support long-term growth.
CAQH Profile Setup & Management
- We create and maintain CAQH profiles by:
- Uploading required documents
- Completing provider information
- Managing attestations
- Monitoring updates
- Accurate CAQH management reduces delays during payer reviews.
Contract Review & Rate Negotiation
Many providers accept payer contracts without reviewing reimbursement opportunities.
MSM Consulting evaluates contract terms, compares reimbursement rates and helps negotiate improved payer agreements.
Out-of-Network Enrollment
For providers who operate outside traditional payer networks, we help establish relationships that support payment processing and reimbursement opportunities.
Primary Source Verification
Our specialists verify provider information directly from reliable sources, including licensing boards, educational institutions and certification organizations.
This helps reduce errors and prevents avoidable payer delays.
Who We Serve
Healthcare Organizations We Credential
MSM Consulting supports credentialing for:
Physicians and group practices
Nurse practitioners & physician assistants
Home health agencies
Hospice providers
Healthcare staffing companies
Behavioral health organizations
DME/HME providers
Specialty pharmacies
Assisted living facilities
Rehabilitation providers
NEMT companies
Home care agencies
Insurance Networks & Payers We Work With
MSM Consulting manages enrollment with major federal programs, commercial insurance companies and specialty payer networks. Our team understands payer-specific requirements, portals, documentation standards, and approval processes.
Payer | Typical Enrollment Timeline | Support Provided |
Medicare (CMS) | 60–90 days | PECOS enrollment, provider setup, NPI verification, billing information review |
Medicaid (State Programs) | 45–120 days | State-specific enrollment support, documentation preparation, portal submissions |
UnitedHealthcare | 60–120 days | Commercial, Medicare Advantage, Medicaid managed care, and subsidiary network enrollment |
BlueCross BlueShield | 60–150 days | State-specific BCBS enrollment requirements, payer communication, application tracking |
Aetna / CVS Health | 60–90 days | Commercial, Medicare Advantage, Medicaid managed care enrollment |
Cigna, Humana & Other Payers | 45–90 days | Regional, specialty, workers’ compensation, and managed care enrollment |
Typical Credentialing Timelines at a Glance
Actual timelines depend on payer workload, application accuracy, provider type, and documentation completeness.
Process | Average Timeline |
Medicare Enrollment | 60–90 days |
Commercial Payer Enrollment | 30–120 days |
Medicaid Enrollment | 45–120 days |
Re-Credentialing | 30–60 days |
MSM Consulting’s follow-up system helps identify delays early and keeps every application moving forward.
How We Work
Our Credentialing Process: Simple, Transparent, Thorough
A clear, structured process means no surprises — and no revenue gaps caused by application errors or missed follow-ups.
1
Initial Consultation & Needs Assessment
We start by assessing your company, the type of provider locations, specialties, location and goals of the payer.
The team at e-Learning determines the most effective method to enroll. Then it creates an outline for the timeframe you must follow to meet the requirements for your credentials.
2
Document Collection & Verification
- We provide a detailed documentation checklist and collect all required information, including:
- Professional licenses
- DEA registration
- Malpractice insurance
- Education records
- Work history
- Certifications
- Each document is reviewed for accuracy before submission.
3
CAQH Profile Creation & Maintenance
We update or create CAQH profiles. We also upload supporting documents and provide full provider attestations.
Maintaining accurate CAQH information helps prevent unnecessary payer delays.
4
Application Preparation & Submission
Our specialists create payer-specific applications and then submit them to the appropriate portals for payment as well as submission channels.
We ensure all required fields, attachments and supporting documents are included.
5
Bi-Weekly Follow-Up & Status Updates
- We follow up with payers every two weeks to:
- Check application status
- Respond to additional requests
- Resolve missing information
- Escalate delayed applications
- Clients receive regular updates throughout the process.
6
Contract Review & Rate Negotiation
Before accepting payer agreements, we review contract terms and reimbursement structures.
Our team evaluates fee schedules and identifies opportunities for improved payment rates.
7
Final Approval & Enrollment Confirmation
- After approval, we confirm:
- Effective dates
- Provider identification numbers
- Billing setup
- Payer participation status
- You receive a complete enrollment summary for your records.
8
Ongoing Monitoring & Re-Credentialing
- Credentialing does not end after approval.
- We continue monitoring:
- License renewals
- Certification updates
- Payer deadlines
- Compliance requirements
- Re-credentialing activities are started in advance to prevent network interruptions.
We continue as your credentialing partner after enrollment — tracking all license, certification, and payer renewal deadlines, initiating re-credentialing 90+ days in advance, and notifying you of any compliance action required.
Starting a New Practice or Agency?
MSM Consulting can help establish your complete credentialing infrastructure, including NPI setup, CAQH management, Medicare enrollment, Medicaid enrollment, and commercial payer applications.
The Difference It Makes
Managing Credentialing Yourself vs. vs. Working With MSM Consulting
VS
Managing Credentialing Internally
- Applications may contain missing information or errors
- Limited follow-up with payers
- CAQH profiles may become outdated
- Renewal deadlines can be missed
- No contract negotiation support
- Staff spends hours on administrative tasks
- Enrollment gaps can affect revenue
MSM Consulting
- Complete application review before submission
- Bi-weekly follow-up on every active file
- Continuous CAQH management and updates
- Proactive re-credentialing tracking
- Contract review and rate analysis
- Your team focuses on patient care
- Continuous payer participation support
Application Denials
What Happens When a Credentialing Application Is Denied?
A denied application does not always mean the process is over. Many credentialing issues can be corrected with proper documentation, communication, and payer-specific knowledge.
MSM Consulting manages denial resolution by:
- Reviewing denial reasons
- Identifying missing or incorrect information
- Preparing corrected applications
- Submitting appeals when required
- Communicating with payer representatives
- Following through until resolution
Common Credentialing Denial Reasons We Resolve
- Missing application information
- Expired CAQH profile
- Incorrect NPI linkage
- Malpractice coverage issues
- Missing DEA information
- License verification problems
- Closed payer panels
- Incorrect practice addresses
- Employment history gaps
Our Track Record
Numbers That Reflect Real Results
18+
Years managing healthcare credentialing
50
States supported nationwide
94%
First-submission approval rate
2400+
Providers credentialed across specialties
Our Experts
Meet Your Credentialing Specialists
Healthcare credentialing requires specialized knowledge of payer rules, compliance standards and provider requirements.
Our team supports organizations across multiple healthcare sectors with payer enrollment, documentation management and compliance monitoring.
Devin Asante
Specializes in Medicare & Medicaid enrollment for home health and hospice providers across 20+ states.
Janet Brown
Manages commercial payer credentialing, CAQH administration, and contract negotiation for physician groups.
Marvin Pike
Expert in healthcare staffing agency credentialing, Joint Commission standards, and multi-state license tracking.
David Morgan
Specializes in DME/HME provider enrollment, DMEPOS supplier enrollment, and out-of-network billing setup.
Need Re-Credentialing Before Your Deadline?
We track all expiration dates and initiate renewals 90+ days in advance so you never lose network status.
Real Results
Client Success Stories
New Agency Fully Enrolled and Billing in 75 Days
A new home health center required Medicare enrollment as well as multiple commercial payer contracts prior to launching.
MSM Consulting created the enrollment strategy, supervised the CAQH setup, mailed the payer applications and monitored follow-ups.
- Results: Full enrollment completed within 75 days, which allowed the agency to start billing according to plan.
Healthcare Staffing Agency — Multiple Providers
Lapsed Credentials Restored Without Billing Interruption
A staffing firm discovered that numerous providers were in need of outdated CAQH information and had missed renewal dates.
MSM Consulting updated profiles, completed re-credentialing applications and coordinated with the payers.
- Result: Provider participation was restored without interruption.
Physician Group Practice — Contract Negotiation
Improved Reimbursement Through Payer Review
A physician group accepted standard payer rates without negotiation.
MSM Consulting analyzed reimbursement structures, compared regional benchmarks, and negotiated improved contract terms.
- Result: Better reimbursement opportunities and stronger payer agreements.
Client Testimonials
What Our Clients Say
Why MSM Consulting
Why Healthcare Organizations Choose MSM for Credentialing
Bi-Weekly Follow-Up on Every Application
We exclusively bill for healthcare providers — not restaurants, law firms, or retail businesses. Every process, every coder, and every workflow is built specifically around healthcare payer rules, coding standards, and compliance requirements.
Deep Payer-Specific Knowledge
Every payer has unique portals, documentation requirements, and internal contacts. Our specialists have processed hundreds of applications with each major payer and know exactly what’s needed to avoid delays.
All 50 States — All Provider Types
State Medicaid programs, state licensing requirements, and state-specific payer contracts vary enormously. Our nationwide team handles credentialing across every state without the learning curve of a local-only service.
End-to-End Service — No Handoffs
From initial setup through ongoing monitoring and re-credentialing, one dedicated team manages your complete credentialing lifecycle. No handoffs between departments, no dropped files, no gaps.
Contract Negotiation Included
Most credentialing services stop at enrollment. MSM Consulting reviews and negotiates payer contracts — ensuring you don’t leave reimbursement on the table by accepting default fee schedules.
Healthcare-Only Specialists
We exclusively serve the healthcare industry. Our team understands the clinical and regulatory context behind credentialing decisions — not just the administrative paperwork — which makes us faster and more accurate.
Frequently Asked Questions
Q. What is healthcare provider credentialing?
Ans. Healthcare provider credentialing is the process of verifying a provider’s qualifications, including licenses, education, training, certifications, and work history, to confirm they meet payer and accreditation requirements.
Without credentialing, providers generally cannot participate in insurance networks or receive reimbursement from those payers.
Q. How long does provider credentialing and insurance enrollment take?
Ans. The timeline varies depending on the payer, provider type, state requirements and application completeness.
Most enrollments take between 45 and 120 days, although some payer processes may take longer.
Q. What payers can MSM Consulting help me enroll with?
Ans. We support enrollment with Medicare, Medicaid, UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna, Humana, and many regional and specialty payers.
Q. Can MSM Consulting help with re-credentialing?
Ans. Yes. We track renewal deadlines, prepare documentation, update payer records, and manage the re-credentialing process before expiration dates.
Q. What is CAQH and do you manage CAQH profiles?
Ans. CAQH ProView is a provider database used by many commercial insurers.
MSM Consulting creates, updates, and maintains CAQH profiles to ensure accurate information is available to payers.
Q. Do I need hospital affiliation to get credentialed with insurance companies?
Ans. Requirements vary by payer and specialty. Some insurance networks may require hospital affiliation, while others may not.
Our team reviews payer-specific requirements before submission.
Q. What is the difference between credentialing and enrollment?
Ans. Credentialing verifies a provider’s qualifications — including licenses, education, training, and work history — against payer and accreditation standards.
Enrollment is the separate administrative process of adding an already credentialed provider to an insurance payer’s network so they can submit claims and receive reimbursement.
Credentialing must happen first; enrollment cannot be completed without it.
Q. What happens if a credentialing application is denied?
Ans. A denial can often be corrected through proper review, additional documentation and payer communication.
MSM Consulting analyzes the denial reason, prepares corrections, and manages the appeal or resubmission process.
Q. Can you credential an entire healthcare staffing agency with multiple providers?
Ans. Yes. We support healthcare staffing companies with multi-provider enrollment, CAQH management, payer applications, and ongoing compliance tracking.
Stop Losing Revenue to Credentialing Delays
MSM Consulting helps healthcare organizations simplify credentialing, maintain payer participation, and protect revenue.
Our specialists evaluate your current enrollment status, identify gaps and create a strategy to keep your providers active and billable.