Service
Medical credentialing services: get providers in-network without the paperwork
Credentialing is how a payer verifies a provider so claims can be paid. Optimus handles applications for government and commercial payers, NPI, CAQH and PECOS registrations, licensing and hospital privileges from $100 per payer plan.
What is included
What you get
- 01
Government program enrollment
Medicare and Medicaid enrollment, including PECOS (Medicare's enrollment system) for providers who bill Medicare.
- 02
Commercial payer credentialing
Applications, follow-up and status updates for each commercial plan you want to join.
- 03
NPI and CAQH
NPI (the provider's national ID) and CAQH ProView, the profile payers read, are set up and kept current.
- 04
Licensing and certification
State licenses, DEA and board certifications tracked so nothing expires during an application.
- 05
Hospital privileges
Applications and documentation for the facilities your providers admit to.
- 06
Ongoing support
Re-attestation reminders and renewals continue after approval, so enrollment does not lapse.
How it works
How we work with you
- 01
Collect the documents
We list what each payer needs and collect it once, so providers are not asked twice.
- 02
Complete and submit applications
We fill in and submit each application and attest the CAQH profile.
- 03
Chase every payer
We follow up until each payer responds, and report status to you weekly.
- 04
Confirm and maintain
Once approved, we confirm effective dates and keep renewals on a calendar.
FAQ
Answers before you ask
How much does credentialing cost?
From $100 per payer plan. That covers the application work for that plan, including follow-up.
What is the difference between credentialing and contracting?
Credentialing verifies the provider's qualifications. Contracting sets the rates and terms the payer pays. A provider usually needs both before claims are paid at in-network rates.
How long does credentialing take?
It depends on the payer. Timelines are set by payers, not by us, so we start early and follow up until each one responds. In one pediatric practice, 14 payers were approved in 45 days.
What is CAQH?
CAQH ProView is the online profile many commercial payers use to verify a provider. It must be re-attested regularly, and we keep it current.
Do you handle Medicare and Medicaid?
Yes. We handle government program enrollment, including PECOS for Medicare, and commercial plans.
Ready when you are
Give your practice the revenue cycle it deserves
Book a demo or get a free, no-obligation billing audit. We will show you where revenue is leaking and what it would take to fix it.