Credentialing & Enrollment Services
Get Credentialed. Get Paid. Stay Compliant.
MSM Consulting manages the entire provider credentialing and insurance enrollment process — from Medicare and Medicaid to commercial payers — so your organization can bill without delays, gaps, or compliance risk.
- 18+ Years of credentialing expertise
- 50 States served nationwide
- 100+ Payer networks supported
- Bi-Weekly Application follow-up on every file
- 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?
Many healthcare organizations lose thousands of dollars every month because of credentialing delays, incomplete applications, or lapsed enrollments. Understanding these two distinct but connected processes is the first step to protecting your revenue.
At MSM Consulting, we manage both processes end-to-end — from initial application preparation through final payer approval and ongoing credential monitoring — for healthcare providers and organizations across all 50 states.
- ⚠️ The Real Cost of Poor Credentialing
- Claims denied or delayed — no payment for services rendered
- Gap in payer enrollment = $0 reimbursement during that period
- Lapsed credentials create compliance violations and liability
- Missed re-credentialing deadlines can trigger network termination
- Errors in applications extend enrollment by months
- Credentialing: The formal process of verifying a healthcare provider's qualifications — including education, training, licenses, certifications, and work history — to confirm they meet the standards required by payers, hospitals, and accreditation bodies. Credentialing must be completed before a provider can participate in any insurance network.
- Enrollment: The administrative process of formally adding a credentialed provider to an insurance payer's network — including Medicare, Medicaid, and commercial insurers — making them eligible to submit claims and receive reimbursement for services delivered to that payer's covered members.
- Re-Credentialing: The renewal of a provider's credentials with payers and facilities, typically required every 2–3 years. Missing re-credentialing deadlines can result in termination from payer networks and loss of billing rights. MSM Consulting tracks all expiration dates and initiates renewals proactively.
- CAQH ProView: The centralized industry database used by most major commercial payers to verify provider credentials. MSM Consulting creates, maintains, and attests CAQH profiles on behalf of providers to ensure payers always have current, accurate information on file.
Losing Revenue to Credentialing Delays?
Tell us your situation. We’ll identify the bottleneck and get your enrollment back on track — fast.
Our Services
Complete Credentialing & Enrollment Solutions
Every service is managed by experienced credentialing specialists who understand payer-specific requirements, state regulations, and the timelines that affect your cash flow.
Provider Credentialing Applications
We prepare, complete, and submit all credentialing applications for individual providers and group practices — ensuring every form is accurate, complete, and submitted to the right payer contacts the first time.
Medicare & Medicaid Enrollment
We manage the full Medicare enrollment process via PECOS and handle Medicaid enrollment across all 50 state programs — including NPI registration, taxonomy code selection, and billing address verification.
Commercial Payer Network Enrollment
We enroll providers with all major commercial insurers including Aetna, BlueCross BlueShield, Cigna, Humana, UnitedHealthcare, and specialty payers — matching your payer mix to your patient population and specialty.
Payer Network Research & Strategy
Our specialists analyze your patient demographics, specialty, geography, and service mix to identify the most valuable payer networks for your practice — maximizing both reimbursement rates and patient access.
CAQH Profile Setup & Management
We create, complete, and maintain CAQH ProView profiles for all providers — uploading required documentation, tracking attestation deadlines, and ensuring your profile is always current and approved by payers.
Contract Review & Rate Negotiation
We review payer contracts and negotiate reimbursement rates on your behalf — benchmarking against regional competitors to secure the highest available rates for your procedures and service types.
Re-Credentialing Services
We track all credentialing expiration dates across every payer relationship and initiate re-credentialing proactively — eliminating the risk of network termination due to missed renewal deadlines.
Out-of-Network Enrollment
For providers who need to remain out-of-network or whose panels are currently closed, we assist in establishing out-of-network relationships with payers to ensure payment processing for those patient encounters.
Ongoing Credential Monitoring
We provide continuous monitoring of provider credentials — tracking license expirations, DEA renewals, board certifications, malpractice insurance, and CME requirements — across your entire provider roster.
Who We Serve
Healthcare Organizations We Credential
Our credentialing specialists have direct experience with the unique payer requirements, documentation standards, and regulatory nuances of each provider type below.
Home Health Agencies
Physicians & Group Practices
Nurse Practitioners & PAs
Healthcare Staffing Agencies
Hospice Providers
Home Care Agencies
DME / HME Providers
NEMT Companies
Behavioral Health Providers
Specialty Pharmacies
Assisted Living Facilities
Rehab & Therapy Providers
Payer Coverage
Insurance Networks & Payers We Work With
We handle enrollment with all major federal programs and commercial payers. Our team understands each payer’s specific portal, documentation requirements, and typical processing timelines.
Medicare (CMS)
Federal health insurance program for individuals 65+ and qualifying disabled persons. We manage all Medicare Part A, Part B, and DMEPOS enrollments via the PECOS system, including NPI and billing group setup.
- Typical Enrollment: 60–90 Days
Medicaid (State Programs)
State-administered programs serving low-income populations. Each state has its own portal and requirements. We manage Medicaid enrollment across all 50 states and handle state-specific documentation nuances.
- Typical Enrollment: 45–120 Days (varies by state)
UnitedHealthcare
The largest commercial payer in the US. We manage UHC credentialing and enrollment including all subsidiary networks — UMR, All Savers, and commercial, Medicare Advantage, and Medicaid managed care plans.
- Typical Enrollment: 60–120 Days
BlueCross BlueShield
A national network of independent BCBS companies. We manage enrollment with BCBS plans in each state, navigating their independent credentialing requirements, portals, and provider relations contacts.
- Typical Enrollment: 60–150 Days
Aetna / CVS Health
We manage Aetna commercial, Medicare Advantage, and Medicaid managed care enrollment — including Aetna Better Health state-specific plans — handling all NaviNet portal submissions and follow-ups.
- Typical Enrollment: 60–90 Days
Cigna, Humana & Others
We enroll providers with Cigna, Humana, Molina, Centene, Wellcare, and dozens of regional and specialty payers — including workers’ compensation, no-fault, and specialty managed care organizations.
- Typical Enrollment: 45–90 Days
Typical Enrollment Timelines at a Glance
Actual timelines depend on payer volume, application completeness, and panel status. MSM Consulting’s follow-up process minimizes delays at every stage.
60–90
days
30–120
days
45–120
days
30–60
days
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 understanding your organization type, specialty, patient population, and payer goals. We identify which payer networks align with your service mix and establish a prioritized enrollment plan with timelines.
2
Document Collection & Verification
We provide a complete documentation checklist and collect all required credentialing materials — licenses, DEA registration, malpractice insurance, education records, work history, and references — verifying each for accuracy before submission.
3
CAQH Profile Creation & Maintenance
We create or update your CAQH ProView profile, upload all supporting documentation, and complete attestation — ensuring your centralized credential profile is current, complete, and approved before payer applications are submitted.
4
Application Preparation & Submission
Our specialists prepare and submit payer-specific credentialing and enrollment applications via each payer’s portal or paper process — ensuring all required fields, attachments, and supporting documents are included and error-free.
5
Bi-Weekly Follow-Up & Status Updates
We follow up with every payer every two weeks — tracking application status, responding to requests for additional information, and escalating when processing is delayed. You receive regular status updates so you’re never left wondering.
6
Contract Review & Rate Negotiation
Before you sign with any payer, we review contract terms and negotiate reimbursement rates — benchmarking against regional fee schedules and competitor rates to ensure you’re receiving fair compensation for your services.
7
Final Approval & Enrollment Confirmation
Once approved, we confirm your effective date, provider ID numbers, and billing setup with each payer — and deliver a complete enrollment summary with all payer IDs, effective dates, and contact information for your records.
8
Ongoing Monitoring & Re-Credentialing
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?
We’ll set up your entire credentialing infrastructure from scratch — NPI, CAQH, Medicare, Medicaid, and commercial networks.
The Difference It Makes
Managing Credentialing Yourself vs. With MSM Consulting
VS
Handling Credentialing In-House
- Applications submitted with errors — rejected or delayed
- No follow-up system — applications fall through the cracks
- CAQH profile outdated — payers flag it as non-compliant
- Missed re-credentialing deadline — network termination
- No contract negotiation — accepting whatever rate is offered
- Enrollment gaps = months of unbillable services
- Staff time consumed by administrative follow-up calls
Credentialing with MSM Consulting
- Error-free applications submitted with all required documents
- Bi-weekly follow-up on every active application
- CAQH always current, attested, and approved by payers
- Re-credentialing initiated 90+ days before deadlines
- Contract rates negotiated against regional benchmarks
- Continuous enrollment — no revenue gaps
- Your team focuses on patient care, not paperwork
Application Denials
What Happens When a Credentialing Application Is Denied?
A denial is not final — but without expert guidance, it can mean months of additional delay and lost revenue. MSM Consulting has managed hundreds of payer appeals and resubmissions, with deep knowledge of the specific documentation and language each payer requires in dispute resolution.
When a denial occurs, we immediately analyze the reason, gather additional supporting documentation, and manage the full appeals or resubmission process on your behalf.
- Analyze the denial notice and identify the exact reason for rejection
- Gather additional documentation or clarifications required by the payer
- Prepare and submit a formal appeal or corrected application
- Escalate to payer provider relations contacts when necessary
- Follow up until resolution is confirmed and enrollment is active
Most Common Denial Reasons We Resolve
- Incomplete or missing application fields
- CAQH profile expired or not attested
- NPI not linked to correct billing group
- Malpractice coverage gaps or incorrect dates
- Missing DEA registration or taxonomy code
- License primary source verification failure
- Closed panel — requires out-of-network enrollment
- Incorrect address or group contract linkage
- Work history gaps flagged during review
Our Track Record
Numbers That Reflect Real Results
18+
50
States where we manage payer enrollment
94%
First-submission approval rate
2400+
Providers credentialed across all specialties
Our Experts
Meet Your Credentialing Specialists
Healthcare credentialing requires specialists, not generalists. Our team has direct experience navigating payer portals, state licensing boards, and accreditation requirements across all provider types.
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 & Billing in 75 Days
A startup home health agency needed Medicare enrollment plus four commercial payer networks before their planned launch date. They had no existing credentialing infrastructure, no CAQH profiles, and no provider IDs.
MSM Consulting established their PECOS enrollment, set up all CAQH profiles, submitted applications to all five payers simultaneously, and managed follow-up with each — completing full enrollment 15 days ahead of the target launch date.
- Fully enrolled in 75 days · First claims submitted on opening day
Lapsed Credentials Reinstated Without Revenue Gap
A healthcare staffing agency discovered that 6 of their 18 providers had lapsed CAQH attestations and two had missed re-credentialing deadlines with a major commercial payer — placing them at risk of network termination.
MSM Consulting immediately updated all CAQH profiles, completed emergency re-credentialing applications, and managed payer communications to prevent termination. All 6 providers were reinstated without any billing interruption.
- 6 providers reinstated · Zero billing interruption · No revenue gap
Reimbursement Rate Increased Through Contract Negotiation
A physician group practice accepted the standard fee schedule offered by a major commercial payer without negotiation — and had been operating at below-market rates for two years. They engaged MSM Consulting during re-credentialing.
Our team benchmarked their rates against regional competitors, identified a significant underpayment gap, and negotiated an improved fee schedule with the payer’s provider relations team during the re-credentialing process.
- Fee schedule improved · Increased annual reimbursements
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
Answers to the most common questions healthcare providers ask before starting the credentialing and enrollment process.
Ans. Healthcare provider credentialing is the formal process of verifying a provider’s qualifications — including licenses, certifications, education, training, and work history — to confirm they meet the standards required by payers, hospitals, and accreditation bodies. Without credentialing, providers cannot participate in any insurance network or receive reimbursement for services delivered to insured patients.
Ans. Timelines vary by payer and provider type. Medicare enrollment typically takes 60–90 days via PECOS. Commercial payer enrollment ranges from 30–150 days depending on the payer’s processing volume and whether panels are open. Medicaid timelines vary by state, ranging from 45–120 days. MSM Consulting’s proactive bi-weekly follow-up process minimizes delays at every stage and keeps your applications moving forward.
Ans. MSM Consulting assists with enrollment in Medicare (CMS/PECOS), Medicaid across all 50 state programs, and commercial payers including UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna, Humana, Molina, Centene, Wellcare, and dozens of regional and specialty payers. We also assist with workers’ compensation, no-fault insurance, and managed care organizations relevant to your specialty and geography.
Ans. Yes. Re-credentialing is one of our core ongoing services. We track all credentialing and payer enrollment expiration dates across your entire provider roster, initiate re-credentialing applications 90+ days before each deadline, and manage the renewal process from start to finish — ensuring no provider ever loses network status due to a missed renewal.
Ans. CAQH ProView is the centralized credentialing database used by most major commercial payers to verify provider credentials. It must be complete, current, and attested to before most commercial payer applications can be processed. MSM Consulting creates, completes, and maintains CAQH profiles for all providers we work with — uploading all required documentation and ensuring attestation deadlines are never missed.
Ans. No. Hospital affiliation is not required for insurance credentialing or payer enrollment. MSM Consulting works with independent providers, clinics, home health agencies, hospice organizations, DME companies, staffing agencies, and private practices to complete all forms of payer enrollment regardless of hospital affiliation status.
Ans. If a credentialing application is denied, MSM Consulting analyzes the specific reason provided by the payer, gathers any additional documentation or clarifications required, prepares and submits a formal appeal or corrected application, and manages all follow-up communications until the matter is resolved. Our experience with payer-specific denial reasons significantly reduces the likelihood of denial in the first place — but when it occurs, we handle it completely on your behalf.
Ans. Yes. MSM Consulting specializes in managing credentialing for healthcare staffing agencies with large provider rosters — tracking individual licenses, certifications, payer enrollments, and compliance requirements across dozens or hundreds of providers simultaneously. We provide a centralized credential management system and proactive renewal notifications to ensure your entire workforce remains continuously compliant and enrolled.
Stop Losing Revenue to Credentialing Delays.
Our credentialing specialists will assess your current enrollment status, identify gaps, and build a plan to get you fully enrolled and billing — without the administrative burden on your team.