Physician Credentialing Services to Accelerate Your Practice Growth

Physician credentialing services involve verifying a healthcare provider’s qualifications, licensure, training, and work history to ensure they meet the standards required by insurance networks, hospitals, and government payers.

Without insurance credentialing, providers cannot join payer networks or receive reimbursement for services. It’s essential for billing Medicare, Medicaid, and commercial insurance companies.

You typically need a state medical license, DEA certificate, malpractice insurance, education history, work experience, NPI number, and a completed CAQH profile.

The provider credentialing process can take between 60 and 120 days depending on the payer, specialty, and state. Working with a credentialing company can help reduce delays.

Credentialing verifies your qualifications, while provider enrollment involves submitting applications to payers and getting approved to join their network.

Our credentialing specialists handle CAQH registration and PECOS setup, keeping your information updated and aligned with payer requirements for faster approvals.

Yes. Type I is for individual providers and Type II is for practices or organizations. We help you register both during the credentialing setup.

If your application is denied, we identify the reason, fix the issue, and handle resubmission. Our team also works on appeal support when needed.

Recredentialing is the periodic renewal of your enrollment status with insurance payers, typically every 2 to 3 years. We track all deadlines and manage recredentialing for you.

A professional credentialing company helps you avoid missed deadlines, reduces administrative burden, and ensures compliance. It also speeds up approvals and increases your chances of getting enrolled correctly the first time.

Billing focuses on submitting claims and receiving payments, while credentialing verifies a provider’s qualifications to join insurance networks. Both are critical to a healthy revenue cycle.

Credentialing certification is typically earned by completing a recognized training program and passing an exam to become a certified credentialing specialist. PROMBS does not offer certification but works with certified experts.