How long does provider credentialing take?

Usually 45 to 90 days, set by each payer. We keep applications moving with weekly or biweekly follow-up and escalate delays instead of waiting on the payer.

How much do medical credentialing services cost?

It depends on how many providers you have, how many payers each needs, and whether it's one-time enrollment or ongoing maintenance and re-credentialing. We scope pricing to your provider count and payer mix. Call 786-259-0231 for a quote sized to your practice.

What is CAQH and do you manage it?

CAQH ProView is the database most commercial payers pull credentials from. We build and maintain your profile and handle re-attestation every 90 days, which is where most avoidable delays start.

Should I outsource credentialing or keep it in-house?

Outsource when delays are holding up reimbursement, when you're enrolling multiple providers or new locations, or when missed re-attestations keep causing lapses. In-house can work for one stable provider with few payers. We manage 12K+ credentialing contracts, so the payer contacts and follow-up cadence are already built.

Which payers do you work with?

Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealthcare, plus Medicare, Medicaid, managed care organizations, and workers' compensation and specialty networks.

How often do providers need re-credentialing?

Most payers require it every 2 to 3 years, plus periodic CAQH re-attestation and Medicare and Medicaid revalidation. We track the dates and handle renewals so participation is never interrupted.

What happens if an application stalls at a payer?

We escalate. Every application is on a weekly or biweekly check, so a stalled file gets flagged and pushed instead of sitting in a queue. You see it in the per-payer status report either way.

Credentialing Service that keeps revenue movings

Qualigenix runs the full credentialing process for solo provider, independent practices and multi-specialty groups which includes data collection, primary source verification, CAQH, payer applications, and follow-up until approval. We manage 12K+ credentialing contracts and report status on every payer.

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What does a credentialing service actually do?

It gets a provider approved to bill insurance. That means gathering documents, verifying credentials with the primary sources, maintaining the CAQH profile, submitting payer applications, and chasing each one until it's approved. Without it, claims are denied or paid at out-of-network rates. Qualigenix owns all eight steps and tells you where every payer stands.

The revenue your practice actually keeps

PRECISION

Metric	Result
Credentialing contracts managed	0
Documentation and data-verification accuracy	0
CAQH re-attestation cadence we manage	0
Verification standards we work to	0

PROGRESS

Metric	Result
Faster submission to approval Progress	0
Payer approval window we work within	0
Payer types supported Progress	0
Status reporting Progress	0

WHAT CLIENTS SAY

What our clients say about this service

01 / 03

“

Qualigenix made the entire credentialing process incredibly smooth and efficient for our mental health clinic. Their team completed our credentialing promptly and also handled the EDI, ERA, and EFT setup within our EMR without unnecessary delays. Their responsiveness, attention to detail, and proactive communication gave us confidence throughout the process. What could have been a time-consuming and complicated process was handled seamlessly by Qualigenix. We highly recommend their services to any practice looking for reliable and efficient credentialing support.

Susan A

Practice Owner • Archer Counseling Services, LLC

“

Changing our business name and address created an unexpected credentialing challenge, especially while we were waiting on the IRS for the required documentation. The prolonged process was putting our revenue at risk and delaying our ability to operate smoothly. Qualigenix stepped in and took care of the necessary demographic changes across our credentialing. Their team was responsive, knowledgeable, and kept the process moving without unnecessary delays. Thanks to Qualigenix, we were able to get everything updated and get our practice back up and running in no time. Their support made a stressful situation much easier to manage

Addie B

Practice Owner • United Health & Wellness Clinic, PLLC

“

Transitioning our mental health practice from a nonprofit to a for-profit organization created a complex credentialing challenge, especially when it came to becoming in-network with federal payers. We needed extensive research and a clear understanding of the requirements to ensure everything was handled correctly. Qualigenix took the time to understand our situation, guided us through the process, and managed the credentialing from start to finish. Their expertise, attention to detail, and proactive approach made a complicated process feel seamless. We truly appreciate Qualigenix for helping us successfully navigate the transition and complete our end-to-end credentialing.

Tera McDonald

Practice Owner • Transpire Mental Health, LLC

What Qualigenix Does in Credentialing

We assign one credentialing specialist to your account and work the full scope of provider enrollment. Every step is documented and tracked, so nothing sits in a payer queue unnoticed.

Group credentialing

Enroll organizations and group practices with commercial and government payers.

Individual provider credentialing

End-to-end enrollment for physicians and allied health professionals.

Demographic updates

Process name, address, and provider changes across every participating payer.

Additional location credentialing

Credential new locations for existing groups so participation never breaks.

Payer revalidation

Manage Medicare, Medicaid, and commercial revalidation to keep enrollment active.

Re-credentialing

Track and complete the 2 to 3 year cycle so credentials never lapse.

Credentialing follow-up

Monitor pending applications, coordinate with payers, resolve open documentation.

Medicare benefit assignment

Support providers with benefit assignment enrollment and documentation.

How it works

Eight steps from application to payer approval

Credentialing fails on missed re-attestations and stale documents, not on effort. Here's the sequence we run, and where we escalate when a payer stalls.

Provider data collection and profile setup

We gather NPI, state licenses, DEA certificate, board certifications, CV and work history, malpractice COI, CAQH access, hospital affiliations, W-9, and tax ID to build a payer-ready profile.

Primary source verification

We verify licenses, board certification, DEA registration, education, and malpractice history directly with the primary sources, to NCQA and CMS standards.

CAQH management

We build and maintain the CAQH ProView profile and handle re-attestation every 90 days, the single most common cause of avoidable delays.

Payer enrollment applications

We prepare and submit to commercial payers, Medicare, Medicaid, MCOs, and specialty networks, credentials attached and submission tracked.

Contract negotiation and network participation

For new practices and specialists, we review fee schedules, coordinate terms, and manage effective dates.

Follow-up and status tracking

We run weekly or biweekly payer checks, escalate delays, and send regular progress reports.

Re-credentialing and maintenance

We manage the 2 to 3 year recredentialing cycle, CAQH re-attestation, expiring license and insurance tracking, and Medicare and Medicaid revalidation.

Deliverables and reporting

You get status per payer, submission and approval dates, expiring-credential alerts, and contract effective dates.

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Credentialing questions

What practices ask before they hand off credentialing

Straight answers on timelines, cost, CAQH, and when outsourcing pays off.

It manages the whole process of getting a provider approved to bill insurance: documents, primary source verification, CAQH, payer applications, and follow-up until approval. Qualigenix runs all eight steps and reports status per payer. Most practices start with a free credentialing review.