Compliance & Credentialing
Provider Enrollment & CAQH Management — Get In-Network and Get Paid
Being qualified isn’t the same as being able to bill. We enroll your providers with Medicare, Medicaid, and commercial payers, build and re-attest your CAQH ProView profile, and track every deadline — so network participation never lapses and claims never bounce for enrollment reasons.
Quick Answer
Provider enrollment is the service of registering a provider or group with each payer network — Medicare, Medicaid, and commercial plans — so they can bill and participate in-network, including building and re-attesting the CAQH ProView profile on its 120-day cycle. It’s used by clinics, medical practices, behavioral health providers, home care agencies, and NEMT companies whose claims depend on active payer participation. Enrollment is distinct from credentialing: credentialing verifies that a provider is qualified, while enrollment registers that verified provider so the plan will pay. The buyer outcome is network participation that never lapses and claims that don’t bounce for enrollment reasons — with deadlines tracked so a missed revalidation never deactivates a paid provider.
Two different jobs
Credentialing vs. enrollment — and why you need both
Credentialing verifies
Credentialing is qualification verification: confirming licenses, board status, education, work history, malpractice coverage, and sanctions checks. It answers one question — is this provider qualified? It’s the primary-source homework a payer or facility requires before it will consider you. See our credentialing service for that side.
Enrollment gets you paid
Enrollment takes that verified provider and registers them with each payer so claims are payable and the provider is in-network. It answers a different question — can this provider bill this plan? A fully credentialed provider who isn’t enrolled still gets paid nothing. This page handles enrollment and CAQH.
What we handle
What does provider enrollment include?
- Medicare enrollment — CMS-855I/855B/855R applications prepared and submitted through PECOS
- Medicaid enrollment — state program and MCO applications, group linkage, and reassignment
- Commercial payer enrollment — network applications for the plans your patients actually carry
- CAQH ProView setup — profile built, documents uploaded, provider data verified
- CAQH re-attestation — the 120-day cycle managed so your profile never goes stale
- Revalidations — Medicare and Medicaid revalidation deadlines tracked and filed early
- Group & roster maintenance — adds, terms, and location changes kept current with every payer
- Status reporting — one sheet: every payer, every provider, every effective date and blocker
Where enrollment breaks
Why do enrollments stall?
A stale CAQH profile
Commercial payers pull from CAQH ProView. If it’s past its 120-day attestation or missing a current license, the enrollment sits — and nobody tells you. A profile kept current is the quiet prerequisite that keeps every commercial application moving.
Effective dates nobody tracks
Bill before your effective date and the claim denies; bill a plan you were never enrolled with and it denies. Knowing the exact date each provider can bill each plan is the difference between clean claims and a month of rework.
Missed revalidations
Medicare revalidates on a cycle and Medicaid on its own. Miss the notice buried in a portal and an established, paid provider is suddenly deactivated. Recovery is slow and retroactive gaps are painful — early tracking prevents the whole ordeal.
Roster changes that lag
A new provider joins, a location changes, someone leaves — and the payer rosters don’t catch up. Directory and roster drift creates out-of-network surprises and denied claims. Keeping every payer in sync is unglamorous maintenance that protects real revenue.
How it works
How does provider enrollment work?
- 1
Free enrollment review
Tell us your providers, payers, and states. Within 1 business day you get a written review — what’s enrolled, what’s stalled, and what your CAQH profile needs — yours to keep.
- 2
We build and submit
CAQH profiles completed, applications prepared payer by payer, and every packet reviewed before submission. You approve the plan before anything is filed.
- 3
Follow-up until active
Weekly status checks and same-week responses to payer requests. Once active, re-attestations and revalidations move onto the tracking calendar.
Proof, not promises
Enrollment that kept pace with multi-state growth
For 2+ years we have supported a growing East Coast NEMT provider as they expanded from one state to several. Every new state means new payer enrollments, new portals, and a bigger re-attestation calendar — handled in the background while their team stayed on operations and growth.
- New-payer enrollments run alongside daily operations
- CAQH and rosters kept current across every portal
- Revalidations started early — no lapsed participation
- 2+ years retained — still with us today
Portals and systems we work in every week
Independent service provider — not affiliated with or endorsed by CAQH, CMS, or any payer or portal named above.
Cost, honestly
How much does provider enrollment cost?
Four inputs set the price: how many payers you need, how many providers and states are involved, whether we’re enrolling fresh or rescuing stalled work, and whether you want ongoing CAQH and revalidation maintenance. New enrollments are quoted per payer application so the cost is clear before we start; maintenance is a flat monthly service. A dedicated enrollment seat typically runs 35–70% less than fully-loaded in-house staff — wages, taxes, benefits, turnover — per SS Support Network operations data. No setup fees.
Providers rarely lose network status to a rejection. They lose it to a re-attestation nobody watched and a revalidation notice buried in a portal. Enrollment is a calendar discipline as much as a paperwork one.
— SS Support Network enrollment playbook
Common questions
Payer enrollment and CAQH, answered straight
Provider enrollment is the process of getting a provider or group approved to bill and participate with each payer network — Medicare, Medicaid, and commercial plans. It covers applications, PECOS and payer portals, effective dates, and network participation. Without enrollment, a fully credentialed provider still cannot be paid by a plan.
Credentialing verifies a provider's qualifications — licenses, education, work history, and sanctions. Enrollment then registers that verified provider with each payer so claims get paid and the provider is in-network. Credentialing answers "are they qualified?"; enrollment answers "can they bill this plan?" We handle both, and this page focuses on enrollment and CAQH.
CAQH ProView is the online profile most commercial payers pull credentialing data from. It must be re-attested every 120 days and kept current, or enrollments stall and network status lapses. We build the profile, upload supporting documents, and manage re-attestation on schedule so payers always see a complete, current record.
Yes. We prepare CMS-855 applications through PECOS for Medicare, and state program plus MCO enrollments for Medicaid, including reassignment of benefits, group linkage, and revalidations. We track every effective date and revalidation deadline so participation never lapses — the most common cause of sudden claim denials for an established practice.
The payer controls the clock — commercial enrollment often runs 60 to 120 days, and Medicare and Medicaid are similar. What we control is what causes most delays: incomplete applications, missing CAQH attestations, and unanswered payer requests. Complete submissions and scheduled follow-up are the fastest route; no honest vendor can promise a payer's timeline.
Yes. Enrollment is not one-and-done. CAQH re-attests every 120 days, Medicare revalidates on a cycle, and commercial plans require periodic updates. We keep every deadline on a tracked calendar and start early, because most providers lose network participation to a missed re-attestation, not a rejected application.
Price follows the number of payers, providers, and states involved, and whether we are enrolling fresh or fixing stalled work. New enrollments are quoted per payer application; CAQH maintenance and ongoing re-attestation are a flat monthly service. A dedicated seat typically runs 35–70% less than in-house staff, per SS Support Network operations data.
Not sure which payers you’re actually enrolled with? Call +1 (657) 777-0006 — 24/7 — and ask for an enrollment review.
Related
Enrollment connects to
Provider Credentialing
The verification step that comes first — licenses, quals, and sanctions confirmed before any payer will enroll you.
Learn more
Medicaid Paperwork & Compliance
Applications, revalidations, and state correspondence managed year-round.
Learn more
Healthcare Back-Office Support
Enrollment, credentialing, billing, and calls — the full admin stack for healthcare businesses.
Healthcare overviewFree enrollment review
Find out what’s stalling your enrollments
Tell us your providers, payers, and states. Within 1 business day you get a written review: what’s active, what’s stalled, what your CAQH profile needs, and real pricing — no sales pressure.
Prefer to talk now? Call +1 (657) 777-0006 or WhatsApp us — 24/7.
