Credentialing
Credentialing
At HealthsDriven, we handle your entire credentialing process from start to finish — so you can focus on patient care while we ensure your agency is fully enrolled, compliant, and ready to get paid.
Why Credentialing Delays Cost You Revenue
Every day your credentialing is incomplete is a day you cannot bill. Most agencies lose thousands of dollars waiting — HealthsDriven eliminates that wait.
60–120 Day Delays
Incomplete or incorrectly submitted applications are the #1 cause of credentialing delays — adding months to your enrollment timeline.
Lost Revenue
Every week without active enrollment means uncollected claims. Retroactive billing windows are limited — delays are costly and often irreversible.
Compliance Risk
Billing without active enrollment or with lapsed credentials exposes your agency to audits, recoupments, and potential exclusion from Medicare and Medicaid.
Re-Credentialing Lapses
Missed re-credentialing deadlines result in automatic payer disenrollment — stopping your billing without warning until the process is restarted.
Complex Paperwork
Medicare, Medicaid, and commercial payer applications each require different forms, documentation sets, and submission portals — a full-time job on its own.
Provider Turnover Burden
Every time a provider joins or leaves, credentialing must be updated across all payers. Without a system, this becomes a constant administrative burden.
Credentialing Across Every Major Payer Type
We manage enrollment applications across all payer categories — so your agency can bill every insurance type your patients carry.
Medicare
Part A enrollment for home health & hospice agencies, CMS 855A/855B applications, PECOS enrollment, and revalidation management.
Medicaid
State Medicaid enrollment by provider type, HCBS waiver programs, managed care organization (MCO) contracting, and waiver-specific applications.
Commercial Insurance
Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare, Humana, and all major private insurance panel enrollments and contracting negotiations.
Medicare Advantage
Enrollment with Medicare Advantage plans (Part C) such as Humana Gold, UnitedHealth AARP, WellCare, and other MAO-contracted networks.
Managed Care Organizations
MCO credentialing and contracting for Medicaid managed care plans, ensuring your agency is in-network with the plans your clients are enrolled in.
Workers' Comp & VA
Enrollment with Veterans Affairs, TRICARE, and state workers' compensation boards for agencies serving veterans and occupationally injured patients.
Full-Service Credentialing — Done For You
We manage every step of the credentialing process across all payers and provider types so your team never has to chase paperwork again.
Initial Enrollment & Application
We prepare, compile, and submit complete, error-free enrollment applications for all payers — eliminating the back-and-forth that causes months of delay.
- Medicare 855A, 855B, 855I applications
- PECOS online enrollment management
- State Medicaid enrollment by provider type
- Commercial payer applications & contracting
- NPI registration & taxonomy updates
Primary Source Verification
We verify all provider credentials directly with the issuing source — licenses, certifications, education, training, work history, and malpractice records.
- State license verification & expiration tracking
- DEA, board certifications & specialty credentials
- OIG & SAM exclusion database checks
- Malpractice history & liability insurance verification
- Education & training institution confirmation
Re-Credentialing & Ongoing Maintenance
Credentialing does not end at enrollment. We monitor and manage re-credentialing cycles, license renewals, and payer updates so nothing lapses.
- Automated re-credentialing reminders & tracking
- License renewal monitoring across all states
- Payer roster updates for provider additions & terminations
- Address, group, and TIN change notifications to payers
- CAQH profile creation, management & attestation
Application Status Tracking
You should always know exactly where your enrollment stands. We provide proactive updates and follow up with payers on your behalf so nothing gets lost in the pipeline.
- Real-time application status updates
- Proactive payer follow-up calls & inquiries
- Immediate response to payer requests for information
- Effective date confirmation & provider number delivery
- Denial resolution & resubmission support
How Our Credentialing Process Works
A transparent, step-by-step credentialing process that keeps you informed at every stage — from document collection to active enrollment.
Discovery Call & Intake
We assess your agency type, provider roster, states of operation, and target payers to build a custom credentialing roadmap.
Document Collection
We send a clear checklist of required documents — licenses, certifications, insurance, W-9, void check — and follow up until everything is received.
Primary Source Verification
We verify all credentials directly with licensing boards, institutions, and databases — OIG checks, CAQH setup, and exclusion screenings included.
Application Submission
We prepare and submit complete, error-free applications to all target payers simultaneously — Medicare, Medicaid, and commercial plans.
Follow-Up & Status Monitoring
We proactively contact payers, respond to additional requests, and keep you updated with real-time status reports throughout the review period.
Active Enrollment Confirmed
You receive your effective dates, provider numbers, and billing credentials — and we set up re-credentialing reminders so you never lapse again.
Why Providers Choose HealthsDriven for Credentialing
We don't just submit paperwork — we manage your entire credentialing lifecycle with accuracy, urgency, and complete transparency.
98% First-Pass Approval Rate
Our applications are reviewed for accuracy before submission — minimizing rejections, delays, and the need for costly resubmissions.
All 50 States
We credential providers in every state, with deep knowledge of state-specific Medicaid portals, licensing boards, and payer requirements.
Dedicated Credentialing Specialist
You are assigned a single point of contact who knows your file inside and out — no call centers, no repeating yourself to different agents.
Faster Than Industry Average
Our streamlined process and payer relationships help us achieve enrollment faster than agencies who manage credentialing in-house or with generalist vendors.
Real-Time Status Updates
We proactively communicate application milestones, payer requests, and approval confirmations — you always know exactly where your enrollment stands.
100% HIPAA Compliant
All provider data, documents, and communications are handled within a fully HIPAA-compliant framework — protecting your providers and your agency.
In-House vs. HealthsDriven Credentialing
Managing credentialing in-house is expensive, slow, and error-prone. See why hundreds of providers trust HealthsDriven instead.
| In-House / DIY Credentialing | HealthsDriven Credentialing |
|---|---|
| 60–120 day average enrollment timeline | Faster enrollment through error-free, complete first submissions |
| Frequent rejections from incomplete applications | 98% first-pass approval rate with pre-submission quality review |
| No system for re-credentialing deadlines | Automated re-credentialing tracking — zero lapses, zero surprises |
| No visibility into application status | Proactive status updates and dedicated specialist follow-up |
| Expensive full-time credentialing staff required | Cost-effective outsourcing — expert team at a fraction of in-house cost |
Common Credentialing Questions
Answers to the questions healthcare providers ask us most about credentialing.
Call us for an appointment
Feel free to contact us.
Reach to us via our location
View Map