Get in network, one plan at a time, with nothing left to chance.

Prices

Every credentialing item, with what it includes. Flat fees, never a share of what you bill.

Need help with something else, like a denied application or a contract question? Consulting by the hour is $175 per hour.

How it works

1. Pick the plans. We list the plans that cover your area and services, which are open to new providers, and roughly what they pay. Start with the plans your clients actually carry.
2. Gather the packet once. One folder with everything plans ask for, kept current in your client portal. Most delays come from a missing page or a name that doesn't match the IRS letter.
3. CAQH first. Most commercial plans read your CAQH profile instead of a paper application. We build it, upload your documents, authorize your plans to see it and attest it.
4. File and follow up. We file each application complete, then follow up every two weeks (sooner when a plan asks for more) and answer their questions until there's a decision.
5. Review the contract. Before you sign: the rates for your codes, the timely filing limit, termination terms and the effective date. You sign every application and contract yourself.
6. Confirm the effective date. We get each effective date and provider ID in writing and load them into your EHR. Don't see a plan's members as in-network before that date; those claims deny.

You see every application in your portal as it moves: gathering documents, submitted, in review, payer asked for more, approved, contract to sign, contract signed, and in network. If a plan says no or its panel is closed, we tell you plainly and what we can try next.

How long it takes

From a complete application to in-network, by kind of plan. These are typical ranges; plans set their own pace, and some take longer.

Because of these timelines, many clinicians open with self-pay clients and add each plan as it becomes effective. Programs can ask a plan for a single case agreement for one client while a contract is pending.

What we need from you

• Your professional licenses, and your NPI numbers (individual and, for a practice, organization). If you don't have NPIs yet, they're free from NPPES, and every launch package gets them for you.
• A signed W-9 and the IRS letter with your EIN, with the legal name exactly as filed.
• Your malpractice declarations page. Many plans ask for $1 million per claim and $3 million a year.
• A CV with month and year for every job, your diplomas and any board certificates.
• DEA and CLIA certificates, if you have them; a voided check or bank letter for direct deposit.
• For programs: the facility license and the organization's liability certificate.
• Your Social Security number, date of birth and home address. In your portal they're encrypted the moment they're saved and shown masked.

Texas Medicaid and managed care

• Enroll with TMHP first. Texas Medicaid enrollment goes through TMHP's Provider Enrollment and Management System (PEMS). Enrollment alone doesn't put you in network: most Texas Medicaid clients are in managed care.
• Then each managed care plan. STAR, STAR+PLUS, STAR Kids and CHIP clients get care through managed care plans that differ by service area (for example Superior HealthPlan, Wellpoint, Molina and the local plans). Each has its own application and contract. Check HHSC's current list of plans for your area.
• One verification for all of them. Texas Medicaid plans use a single credentialing verification organization run through the Texas Association of Health Plans, so the primary-source checks of your documents run through one place for every Medicaid plan (TAHP).
• LPCs and LMFTs: since March 2024, Texas Medicaid has required Medicare enrollment before Medicaid enrollment, unless you qualify for the pediatric exemption (BCBSTX Medicaid notice).
• SUD programs enroll as a licensed chemical dependency treatment facility. Check which services Texas Medicaid pays your license or program type for before planning on it.
• Revalidate on time. Medicaid enrollment must be revalidated at least every five years, online in PEMS; HHSC suggests filing at least 120 days before your due date. A missed revalidation ends your enrollment (HHSC).

Medicare

• We enroll each clinician and the practice in PECOS and reassign each clinician's billing to the practice. There's no Medicare application fee for individual clinicians or clinician groups.
• Since January 1, 2024, Medicare pays marriage and family therapists and mental health counselors (in Texas, LMFTs and LPCs), alongside LCSWs, psychologists, nurse practitioners and physicians (CMS). Addiction counselors such as LCDCs generally can't bill Medicare on their own.
• Freestanding IOP and PHP programs generally can't bill Medicare for those levels of care; hospitals and community mental health centers can.
• Many older clients have a Medicare Advantage plan instead, and each one credentials you separately, usually after you're enrolled in Medicare.

Keeping it current

Credentials lapse quietly. CAQH needs re-attesting every 120 days or plans can't use it; plans recredential about every three years; Medicare revalidates about every five. Credentialing upkeep is $49 per clinician a month:

• CAQH re-attestation every 120 days
• License, malpractice and DEA expirations tracked and renewed on time
• Recredentialing and Medicare / Medicaid revalidation
• Address, phone and roster changes sent to every plan

Credentialing guides

Doing it yourself, or want to know exactly what we'll do? These guides walk through each piece, and the credentialing cost calculator totals your plans, CAQH, Medicare and Medicaid in a minute.

Questions