Loading...
Credentialing Services in Boston
in Boston, MA
Qualigenix enrolls Boston providers with MassHealth, its health plans, Medicare and commercial payers, then follows every application until the payer decides. Talk to a credentialing specialist at 786-259-0231. HIPAA-compliant, with a signed BAA before we handle provider data.
Request a Callback
Speak with our Credentialing specialists today.
What Credentialing Services Does Qualigenix Provide in Boston?
Qualigenix credentialing services cover the full process for Boston providers and groups: data collection, primary source verification, CAQH ProView management, payer applications, contracting, follow-up and re-credentialing. We work with MassHealth, the MassHealth health plans in Boston, Medicare and commercial payers. Pricing is $99 per payer application. Payers make the final approval decision.
How Qualigenix Serves Boston Practices
Qualigenix credentials physicians, allied health professionals and groups in Boston across 38+ specialties. In Boston, enrollment with MassHealth is only the first step. To see MassHealth members in a managed plan, a practice also has to contract with that plan directly, and Boston has 12 plan options for 2026.
That makes a Boston credentialing file longer than most: MassHealth, the plans you join, Medicare, the SCO and One Care plans your older patients use, and each commercial carrier. Statewide rules, such as MassHealth revalidation and state credentialing timelines, are covered on our Massachusetts credentialing page. This page covers the Boston and Suffolk County plans you'll need to join.
Credentialing With Suffolk County's MassHealth Plans
Qualigenix enrolls each provider with MassHealth first, then with each Boston plan your practice chooses. MassHealth enrollment and revalidation run through its Provider Online Service Center (POSC), and MassHealth asks providers to revalidate at least every five years.
Boston MassHealth Plan Options
MassHealth's January 2026 enrollment guide lists these plans for the Boston service area: Accountable Care Partnership Plans: Fallon Health-Atrius Health Care Collaborative, Mass General Brigham Health Plan with Mass General Brigham ACO, Tufts Health Together with Cambridge Health Alliance (CHA), East Boston Neighborhood Health WellSense Alliance, WellSense Beth Israel Lahey Health (BILH) Performance Network ACO, WellSense Boston Children's ACO, WellSense Care Alliance and WellSense Community Alliance; Primary Care ACOs: Community Care Cooperative (C3) and Revere Health Choice; Managed care organization: WellSense Essential MCO; The MassHealth Primary Care Clinician (PCC) Plan. Primary care providers who join an ACO aren't available as primary care providers in an MCO, so we confirm your plan choices before any application goes out.
Recent MassHealth Plan Changes
When the Tufts Health Together MCO closed on January 1, 2026, practices had to join a MassHealth ACO, MCO or the PCC Plan to keep seeing those members. Revere Health Choice becomes Bookmark Care Network on January 1, 2027. Qualigenix updates plan names and participation records so your directory listings and claims match.
Statewide Credentialing Rules
MassHealth revalidation, licensure checks and state timelines are covered once on our page on Massachusetts provider credentialing rules.
Medicare and Commercial Payers for Boston Practices
Qualigenix files Medicare enrollment through PECOS with National Government Services, the Medicare contractor for Massachusetts, and tracks revalidation dates. For dual-eligible patients, we contract providers with the Senior Care Options and One Care plans they need. Suffolk County has six SCO plans and five One Care plans for 2026, with Mass General Brigham new to both and Molina new to One Care. Massachusetts gives commercial credentialing a clock. State rules expect carriers to finish 95% of clean, complete initial applications within 60 days and to give a status update by day 75. Qualigenix submits clean applications and follows up against those dates. We verify physician licenses with the Massachusetts Board of Registration in Medicine and other licenses with their state boards before any commercial application goes to Blue Cross Blue Shield of Massachusetts, the state's largest commercial insurer, or another carrier.
PROVEN CREDENTIALING PERFORMANCE
Results Boston Practices Can Expect
These are company-wide figures across Qualigenix clients, not Boston-only numbers.
12K+
Credentialing contracts managed
Up to 30% faster
Submission to approval
45-90 days
Payer approval window we work within
99%
Documentation and data-verification accuracy
NCQA and CMS primary source verification
Verification standards
Managed on a 90-day cadence
CAQH re-attestation
Per payer
Status reporting
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsSTRUCTURED 8-STEP WORKFLOW
How Onboarding Works
Qualigenix runs credentialing in eight steps, and your specialist reports status for each payer throughout.
01
Provider Data Collected
We gather NPI, licenses, DEA, board certifications, work history, malpractice coverage, W-9 and CAQH access.
02
Primary Source Verification
Licenses, certifications, DEA, education and malpractice history are verified at the source, to NCQA and CMS standards.
03
CAQH Profile Set Up
We build or clean up the CAQH ProView profile and re-attest it every 90 days.
04
Payer Applications Submitted
Applications go to MassHealth, your chosen plans, Medicare and commercial payers with every document attached.
05
Contracts and Effective Dates
We review fee schedules, coordinate contract terms and confirm each payer's effective date.
06
Weekly Payer Follow-Up
Each pending application gets weekly or biweekly checks, and stalls are escalated.
07
Ongoing Credential Maintenance
Re-credentialing, revalidation and expiring documents are tracked by due date.
08
Per-Payer Status Reports
You get submission dates, approval dates, effective dates and expiring-credential alerts for each payer.
Loading Integrations...
WHY BOSTON PRACTICES CHOOSE QUALIGENIX
Why Boston Practices Choose Qualigenix
Flat per-payer application pricing, dedicated single-specialist ownership, complete per-payer tracking, and seamless integration with billing.
Priced Per Payer Application
Qualigenix charges $99 per payer application, covering full provider credentialing and payer enrollment. You know the cost of each MassHealth plan, Medicare and commercial application before we submit it.
One Specialist Per Account
One credentialing specialist owns your file from first application to re-credentialing. You don't repeat your history to a new person each time a Boston plan asks for documents.
Status for Every Payer
You see where each application stands with each payer: submitted, pending, approved or stalled, with dates. Nothing sits in a MassHealth plan's queue without someone checking on it.
Credentialing and Billing Together
Qualigenix also runs medical billing, so enrollment and claims stay in step. A provider's effective date with each plan is known before the first claim goes out, which prevents enrollment denials.
BOSTON CREDENTIALING FAQS
Frequently Asked Questions
Frequently asked questions regarding Boston MassHealth plan options, Senior Care Options, One Care, PECOS Medicare filing, and provider enrollment.
Qualigenix is a credentialing company serving Boston providers and groups across 38+ specialties. We enroll providers with MassHealth, its Boston plans, Medicare and commercial payers, and we manage 12K+ credentialing contracts. Book a meeting to review your enrollment list.
We complete MassHealth enrollment through its Provider Online Service Center, then contract the provider with each MassHealth plan your practice chooses. MassHealth revalidation is tracked so enrollment stays active at least every five years.
Yes. Qualigenix contracts providers with the Accountable Care Partnership Plans, Primary Care ACOs and the WellSense Essential MCO in the Boston service area. We confirm your plan choices first, since primary care providers in an ACO can't also be primary care providers in an MCO.
Yes. Qualigenix files Medicare enrollment through PECOS with National Government Services, the Medicare contractor for Massachusetts, including benefit assignment and revalidation. We also contract providers with the SCO and One Care plans in Suffolk County.
Qualigenix works within a 45-90 day payer approval window and follows up weekly or biweekly. Massachusetts expects carriers to finish most clean initial applications within 60 days, but each payer makes the final decision.
Qualigenix charges $99 per payer application. That covers full provider credentialing and payer enrollment for that payer. Talk to a credentialing specialist for the total based on your providers and payer list.
No. A Boston practice needs a team that knows MassHealth enrollment, the Boston plans, PECOS and Massachusetts carrier timelines. Qualigenix assigns one specialist to your account and reports status for every payer.