A. General Questions
1. What is medical credentialing?
Credsolutions made the credentialing process simple and stress-free. Their support was exceptional every step of the way!
2. What is the difference between credentialing and payer enrollment?
Credentialing involves verifying a provider’s qualifications and professional background. Payer enrollment involves preparing and submitting applications to insurance companies so providers can participate in their networks and become eligible for reimbursement under payer requirements.
3. Which healthcare providers do you support?
We support physicians (MDs and DOs), nurse practitioners, physician assistants, behavioral and mental health professionals, and other eligible healthcare providers. We also assist individual providers, group practices, and medical clinics.
4. Do you handle individual and group enrollment?
Yes. We assist with individual and group enrollment applications, provider additions, and provider-to-group linking, depending on the payer’s requirements.
5. Which insurance payers do you work with?
We assist with Medicare, state Medicaid programs, Medicaid managed care plans, and commercial insurance payers, including Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield. Availability depends on payer participation requirements and network status.
6. Do you provide Medicaid enrollment in all states?
We assist with state Medicaid and managed care enrollment based on program requirements and service availability. Enrollment procedures and processing times vary by state.
B. Credentialing & Enrollment Services
7. What is included in your credentialing and enrollment services?
Our services may include document collection and review, application preparation, submission, payer follow-up, assistance with outstanding documentation requests, and enrollment status updates.
8. Do you assist with Medicare reassignment?
Yes. We assist with Medicare reassignment and provider-to-group linking through PECOS, subject to applicable Medicare requirements.
9. Do you provide CAQH profile creation and maintenance?
Yes. We assist with CAQH profile creation, updates, document uploads, profile maintenance, and re-attestation.
10. Do you assist with NPI applications?
Yes. We assist with Type 1 and Type 2 NPI applications and NPPES profile updates.
11. Do you assist with professional licensing and DEA registration?
Yes. We provide administrative assistance with state professional licensing applications, renewals, and DEA registration.
12. Do you follow up with insurance payers?
Yes. We follow up with insurance payers to monitor application progress, check outstanding requirements, and communicate payer responses and status updates.
C. Timelines & Application Requirements
13. How long does the credentialing and enrollment process take?
Processing times vary by insurance payer, state, provider type, and application requirements. Some individual Medicaid applications may take approximately 45–60 business days, while facility enrollment and other payer applications may take approximately 60–90 business days. These are estimates, not guaranteed timelines.
14. What documents are required for credentialing and payer enrollment?
Requirements vary by provider type and payer. Common documents include:
- Individual and group NPI information
- Current professional license
- Board certification, if applicable
- Professional liability insurance
- W-9 form
- CAQH profile information
- Practice address and contact details
- Ownership and organizational documents, when applicable
We provide a specific checklist based on your enrollment requirements.
15. How often will I receive enrollment updates?
We generally provide progress updates approximately every 15 business days. We also communicate relevant payer responses, outstanding documentation requests, and application status changes.
D. Pricing, Payment & Policies
16. How much do your credentialing and enrollment services cost?
Our fees depend on the type of service, provider requirements, and insurance payer. We review your requirements and provide a service-specific quotation before beginning work.
17. What is your payment policy?
Payment is required in full after the initial review, confirmation of requirements, and issuance of an invoice. Work begins after payment is received. Any applicable government, payer, licensing, or third-party application fees are separate and remain the client’s responsibility.
18. Do you guarantee insurance enrollment approval?
No. Insurance payer approval, network participation, effective dates, reimbursement rates, and processing timelines are determined by the insurance payer. We provide administrative support with application preparation, submission, and payer follow-up, but cannot guarantee payer decisions.
19. Can you guarantee a specific enrollment completion date?
No. Enrollment completion depends on payer processing, application requirements, and any additional documentation requested. We provide estimated timelines and ongoing follow-up, but final processing dates are outside our control.
20. Do you provide medical billing or RCM services?
No. Credsolutions LLC currently focuses on medical credentialing, insurance payer enrollment, CAQH and NPI management, licensing assistance, and related administrative support. Medical billing and revenue cycle management are not part of our current services.