Medical Credentialing & Provider Enrollment Services
Alpha RCM Solutions handles CAQH, payer applications, follow-up and revalidation, so your providers can get in-network and start billing sooner. We work with physicians, groups, hospitals and allied health providers across the U.S.
- Applications prepared, submitted and tracked start to finish
- Weekly payer follow-up until you’re approved
- CAQH, NPI and revalidation kept current
Request a Free Consultation
Tell us where to reach you and a credentialing specialist will follow up.
Credentialing, Enrollment and Contracting, Explained
Providers often hear these three terms used as if they mean the same thing. They are separate steps, and a delay in any one of them delays your first in-network payment. We manage all three.
Credentialing. The payer verifies your licenses, education, training, work history and malpractice coverage at the source.
Enrollment. You are added to the payer’s network and provider directory, with your NPI, tax ID and practice locations on file.
Contracting. Fee schedules, terms and effective dates are set, so you can bill in-network under the contract.
Credentialing and Payer Enrollment Services
Everything between your first document and your first in-network claim.
Payer Enrollment
Applications for Medicare, Medicaid and commercial plans, prepared, submitted and tracked until approval.
CAQH Setup & Upkeep
We build your CAQH profile, keep documents current and complete re-attestations on time.
NPI, PECOS & NPPES
NPI setup and updates, PECOS enrollment and record changes kept consistent across every system.
State Licensing Support
Help with state license applications and renewals so your licensing data matches every payer file.
Contracts & Fee Schedules
Review of contract terms, fee schedules and effective dates before you sign.
EDI / ERA / EFT Setup
Electronic claims, remittance and payment setup, so you are ready to bill and get paid once approved.
Hospital & Facility Privileges
Coordination with medical staff offices for admitting, courtesy and surgical privileges.
Revalidation & Recredentialing
Expiration dates tracked and renewals filed on schedule, so you stay active in every network.
Supply Program Enrollment
Separate enrollment for DME and medical supply programs, prepared and tracked to approval.
How Our Credentialing Process Works
A clear, trackable path from your first document to an active in-network status.
1Intake & documents
A short interview and a document checklist: licenses, education, work history, malpractice coverage and identifiers.
2Verification & CAQH
We verify your data against primary sources and build or clean up your CAQH profile so every record matches.
3Payer selection
We help you choose which payers to pursue based on your specialty, location, license type and patient mix.
4Application submission
Complete, accurate applications go to each payer, with proof of submission kept on file.
5Follow-up to approval
Weekly payer follow-up, quick answers to payer requests, and regular status updates to you.
6Go-live & upkeep
We confirm effective dates, finish EDI and EFT setup, and track revalidation so you stay in network.
Commercial payer credentialing typically takes 60–120 days, and some plans take longer. Starting early is the best way to avoid a gap in billing.
What We’ll Ask You For
- State medical license(s)
- NPI number and NPPES login
- CAQH ID and login
- Malpractice insurance certificate
- CV with full work history
- Board certification and DEA registration, if applicable
- Tax ID (W-9) and practice location details
- Bank details for EFT setup
Why Applications Get Delayed
Most delays come from small errors, not from payers. One wrong date or a missing document can add months. The usual causes:
- Data that doesn’t match across CAQH, NPPES and licensing records
- Expired or missing documents
- Unexplained gaps in work history
- CAQH profiles that were not re-attested
- Applications that sit without payer follow-up
Why Providers Outsource Credentialing
Credentialing is detail work that has to be done exactly, and payer rules change often. Handing it to a team that does it every day keeps your staff on patient care. Because we also run medical billing, enrollment is set up with billing in mind from the start.
- One team owns every application and every payer follow-up
- Fewer errors and resubmissions from mismatched data
- CAQH attestations and revalidation dates tracked for you
- Less staff time spent on hold with payers
- A faster path to billing in-network
- Credentialing and billing handled by one team
Who We Credential
Proper credentialing is essential for providers to see patients, bill payers and stay compliant. We support providers and organizations of all specialties.
Payers We Enroll You With
Government programs, national commercial plans and regional networks.
Government Payers
- Medicare
- Medicaid (state programs)
- TRICARE
Commercial Payers
- Blue Cross Blue Shield
- Aetna
- Cigna
- Humana
- UnitedHealthcare
- Regional and local plans
Credentialing Packages
Pricing depends on the number of providers and payers. Tell us what you need and we will send a quote.
Basic
Core enrollment support
- Document collection and verification
- Applications completed and submitted to your chosen payers
- Follow-up until approval and contract
- Bi-weekly status updates
Advanced
Enrollment plus ongoing upkeep
- Everything in Basic
- CAQH setup and maintenance
- Payer portal attestations (CAQH, Availity, Optum ID)
- Revalidation and recredentialing
- Monitoring of payer requirement changes
Premium
Support through contracting and setup
- Everything in Advanced
- Contract review and negotiation support
- EDI, ERA and EFT setup
- Billing onboarding support from our billing team
Credentialing FAQs
Straight answers to the questions providers ask us most.
Commercial payer credentialing typically takes 60 to 120 days, and some payers take longer. The biggest causes of delay are incomplete applications and data that does not match across CAQH, NPPES and licensing records. We follow up with payers weekly and keep you updated on status.
Credentialing is the payer verifying your qualifications. Enrollment adds you to the payer’s network and directory. Contracting sets your fee schedule, terms and effective date. All three have to be complete before you can bill in-network.
Typically your state license, NPI, CAQH login, malpractice insurance certificate, CV with full work history, and tax ID. Board certification and DEA registration apply to some providers. We send you a checklist at intake.
Yes, and we recommend starting as early as possible. Payers take weeks or months to process applications, and effective dates are often not backdated, so waiting can mean a gap before you can bill in-network.
Yes. We help with Medicare enrollment, including PECOS, and with state Medicaid programs. Medicaid requirements vary by state, so we confirm the rules for your location up front.
CAQH ProView is a shared provider profile that many commercial plans use to verify your information. It needs to be kept accurate and re-attested regularly, typically every 120 days. We set it up and maintain it for you.
It depends on the number of providers and payers. Request pricing or use the form above and we will send a quote.
Yes. Many clients use us for both. Credentialing sets you up to be paid, and our medical billing team handles claims from there.
Explore Related Services
Medical Billing
Claims, denials and payment posting handled by the same team.
Revenue Cycle Management
End-to-end revenue cycle support for your practice.
Small Practices
Credentialing and billing support sized for small practices.
Large Practices
Support for multi-provider groups and larger organizations.