Medical Billing Services
Medical Billing Services

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Medical Credentialing & Payer EnrollmentServices for Healthcare Providers

Credentialing delays cost real revenue. Every provider who isn't credentialed is a provider you can't bill for. P3Care pairs dedicated enrollment specialists with online application tracking, so providers get approved by Medicare, Medicaid, and commercial payers faster.
Medicare, Medicaid &
Commercial Payer Enrollment.
Primary Source Verification Included.
Dedicated Credentialing Project Manager.
Monthly OIG & SAM exclusion screening.
Definition

What Is Medical Credentialing?

Medical credentialing, sometimes called insurance credentialing or provider enrollment, is the process payers and healthcare organizations use to verify a provider's education, licenses, certifications, and work history before allowing them to treat patients in-network. It confirms a provider meets every legal and payer-specific requirement needed to bill Medicare, Medicaid, and commercial insurance plans.
Problem → Solution

Credentialing Delays Are a Revenue Problem,Not a Paperwork Problem

Delays rarely fail all at once. They stall in small, costly ways: a CAQH profile that lapsed, a missing malpractice certificate, an application sitting untouched on a payer's desk. A November 2025 MGMA Stat poll found that 32% of medical groups report some type of credentialing or reappointment backlog. Every week a provider waits is a week of care you can't bill payers for.

How P3Care Fixes It

  • Complete before submission
    Every application, license, and certificate is checked before it ever reaches a payer.
  • Primary source verification done right
    Education, licensure, and work history confirmed directly with the issuing institutions.
  • Real-time application tracking
    Know exactly where every provider's file stands without calling to ask.
  • Proactive payer follow-up
    We chase the payer on a set schedule, not only when a file goes quiet.
  • Expiration alerts before they lapse
    Licenses, DEA registrations, and malpractice coverage tracked so nothing goes stale unnoticed.
  • One dedicated credentialing manager
    A single point of contact who knows your providers and your timeline.
Core Credentialing Services

Complete Credentialing Services for Every Stage of Enrollment

Provider Enrollment

Get credentialed and enrolled with Medicare, Medicaid, and commercial payers from day one.

CAQH Profile Management

Profiles built, attested, and kept current so no payer request goes unanswered.

Primary Source Verification

Licenses, education, and work history confirmed directly with the issuing source.

NPI Registration

Type 1 and Type 2 numbers registered and kept accurate across every system.

Hospital & Facility Privileging

Applications managed for hospitals, surgery centers, and outpatient facilities.

License & DEA Tracking

State licenses, DEA registrations, and certifications renewed before they lapse.

Re-Credentialing & Revalidation

Every payer's renewal cycle tracked, so active status never lapses.

Payer Contract Review

Fee schedules and participation terms reviewed before you sign.
Payer Network

Enrolled & In-Network With the PayersYour Patients Already Carry

Not sure which payers your specialty should prioritize, or where your enrollment status stands with each one? P3Care manages credentialing and enrollment across national and regional commercial payers, Medicare, and Medicaid, including major carriers like Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield, Humana, Kaiser Permanente, and Molina Healthcare, along with state-specific and regional plans. Whatever your payer mix looks like today, we know how to get you enrolled and keep you active there.
Blue Cross Blue Shield
Optum
Medicare.gov
Medicaid.gov
Humana
UnitedHealthcare
Aetna
Practices We Serve

Credentialing Support Built for Every Practice Size

Solo Providers & Small Practices

For independent providers and small groups without in-house credentialing staff, we manage the full enrollment and insurance credentialing workload start to finish.

Mid-Sized & Multi-Specialty Groups

As your group grows, so does your payer complexity. We keep every provider's CAQH profile, credentialing data, and enrollment status organized as your team scales.

Hospital-Affiliated & Health System Practices

For hospitals and health systems credentialing hundreds of providers, our team manages privileging, enrollment, and revalidation at scale without a single file falling through the cracks.
Process

How the P3Care Credentialing Process Works

01

Document Collection & Application Prep:

We gather licenses, DEA certificates, malpractice coverage, and work history into one complete application package.

02

Primary Source Verification:

Every credential is confirmed directly with the issuing school, board, and licensing agency.

03

CAQH & Payer Submission:

Your CAQH profile is built or updated, and applications go out to Medicare (via PECOS), Medicaid, and commercial payers.

04

Active Follow-Up:

We call and email payers on a set schedule until each application moves forward.

05

Approval & Enrollment Confirmation:

Once approved, we confirm effective dates and network status before you start billing.

06

Ongoing Tracking & Revalidation:

Renewal dates and re-credentialing cycles are tracked so active status never lapses.

Credentialing Timeframes

How Much Faster?
Credentialing Timelines, Compared

Standard payer processing windows are only half the story — active, scheduled follow-up is what actually moves a file forward.
Payer Type
Examples
Standard Industry Timeline
P3Care's Active-Management Timeline
Commercial Payers
Aetna, Cigna, UnitedHealthcare, BCBS
90–120 business days
60–90 business days
Medicare
CMS contractors (Novitas, Noridian, Palmetto)
60–90 days
45–60 days
Medicaid
State-specific programs
60–120 days (varies by state)
45–75 days
Why Choose P3Care

What Better Physician Credentialing Looks Like

Faster Time to Billing
Less time stuck in credentialing limbo means providers start generating revenue sooner.
Fewer Credentialing-Related Denials
Clean, verified applications mean fewer claims rejected over enrollment issues later.
One Point of Contact
A dedicated credentialing manager who knows your providers, deadlines, and payer relationships.
Built for Any Size
Solo providers, multi-specialty groups, and hospitals all get the same organized process.
Full Visibility, No Guessing
Track every application's status online instead of waiting on a callback.
Compliance You Can Rely On
NCQA-aligned verification standards followed on every single file, every time.

What Providers Say About Our Credentialing Team

In-House vs.
Outsourced Credentialing

Handling credentialing in-house means owning every application, every follow-up call, and every renewal deadline yourself. Here's how that compares to working with P3Care.
Factor
In-House Credentialing
Outsourced With P3Care
Cost
Staff hours, CAQH management time,
ongoing training on payer rules
✓ One tailored engagement, no extra hires
Turnaround
Depends entirely on staff bandwidth
and payer patience
✓ Actively managed, with follow-up on
a set schedule
Accuracy
Errors mean resubmission and lost
weeks
✓ Verified against primary sources before
submission
Payer Follow-Up
Often reactive, after a denial or delay
✓ Proactive contact until every file
moves
Visibility
Manual spreadsheets and scattered
email threads
✓ Real-time status through your dedicated
manager
Revalidation
Easy to miss amid daily operations
✓ Tracked automatically, well before
deadlines
Pricing

How Much Do Credentialing Services Cost?

Credentialing pricing depends on your provider count, payer mix, and whether you need new enrollment or revalidation. P3Care offers tailored pricing with no long-term contract required. Every engagement starts with a free credentialing audit, so you see exactly what's outstanding and what it's costing you before you commit.

Credentialing for Every Specialty

Board requirements, hospital privileging rules, and payer quirks change by specialty. Our credentialing team already knows them.
Compliance & Data Security

Credentialing You Can Trust

HIPAA-compliant document handling
encrypted in P3Merge
  • Primary source verification aligned with NCQA standards.
  • Monthly OIG and SAM exclusion and sanctions screening.
  • Business Associate Agreements before any credential data changes hands.
  • CAQH attestations kept current and audit-ready.
  • Ongoing staff training on payer and regulatory updates.

Credentialing Support Across the United States

State licensing requirements, Medicaid regulations, and payer networks vary widely. Our credentialing team supports healthcare practices in every state.
Map of the United States highlighting service coverage and provider network distribution for P3 Healthcare Solutions.

Frequently Asked Questions

Credentialing verifies a provider's qualifications; enrollment is applying to join a payer's network. P3Care handles both together, so verification flows straight into an active, billable contract.

Most payers recredential every two to three years, though requirements vary by plan. We track every provider's renewal window so active status never lapses.

Pricing depends on your provider count, payer mix, and whether it's new enrollment or revalidation. Start with a free credentialing audit, and we'll build a tailored quote.

Yes. We track state-specific licensing boards, Medicaid rules, and payer requirements so multi-location and multi-state practices stay compliant everywhere they operate.

Directly. An uncredentialed provider's claims can't be billed at all. Faster, cleaner credentialing means revenue starts the moment a provider sees patients.

Most applications take 90 to 120 days from submission to approval, depending on the payer and how complete your documentation is. Active follow-up keeps files from stalling in a queue.

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We primarily provide HIPAA-compliant medical billing services along with MIPS consulting and reporting services. As your HIT consultant, we optimize providers’ performance for improved RCM.

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