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How much does insurance credentialing cost? Price yours
The government parts are free: an NPI, a CAQH ProView profile and Medicare enrollment for an individual clinician cost nothing to file. What you pay for is the work of filing complete applications and chasing them to an effective date. Our flat prices are $175 for each clinician with each plan and $250 to build a CAQH profile, so a solo LPC with CAQH and four commercial plans is $950. Most plans take 60 to 120 days.
Updated October 24, 2026. Prices are the same ones on every Cima Consulting page; plans set their own pace, so timelines are typical, not promised.
The calculator
The calculator needs JavaScript. Without it, the worked examples and the price table below give the same numbers for the common cases.
Count a plan once per clinician: two therapists joining the same plan are two applications. Texas Medicaid enrollment already includes the first Medicaid managed care plan, so count only the managed care plans after that one in the plans line. Opening a new program or group? A facility or group contract is the organization's own contract; each clinician may still need to be linked to it.
Worked examples
The same prices, added up for the cases we see most. The upkeep column is optional; it's what keeps the profiles and enrollments from lapsing after you're in network.
| Example | One-time | Upkeep a month |
|---|---|---|
| A solo LPC: CAQH and 4 commercial plans | $950 | $49 |
| A solo LPC: CAQH, Medicare and 4 plans | $1,300 | $49 |
| A psychiatric NP: CAQH, Medicare, Texas Medicaid and 5 plans | $1,825 | $49 |
| A group adding 3 clinicians: CAQH and 5 plans each | $3,375 | $147 |
| An IOP/PHP program: 6 facility contracts | $2,700 | — |
A brand-new solo practice usually gets more for its money from a launch package than from these items alone: Solo Practice Launch: Essentials ($1,950) includes the CAQH profile and 3 plans along with the NPIs, the policies and client forms, and the EHR set-up; Solo Complete ($3,450) includes 6 plans and billing set-up. Already open? The per-item prices are all you need.
What's free and what isn't
| Item | Government or third-party fee | Where |
|---|---|---|
| EIN (tax ID) | Free | IRS |
| NPI, individual (Type 1) and organization (Type 2) | Free; usually issued within days | NPPES |
| CAQH ProView profile | Free for providers; re-attest every 120 days | CAQH ProView |
| Medicare enrollment | No application fee for individual clinicians or clinician groups | PECOS |
| Texas Medicaid enrollment | Check TMHP's current requirements for your provider type | TMHP |
So the cost of credentialing is time: building the CAQH profile, filling each plan's application so its names, addresses and dates match exactly, answering the plan's questions, and following up until there's a decision. That's what the prices below pay for.
Every price, and what it includes
Flat fees, never a share of what you bill. You sign every application and contract yourself; we prepare them, file them and follow them up. Full details on the credentialing service page.
| Service | Price |
|---|---|
| CAQH ProView profile Your CAQH profile built from your documents, uploaded, authorized for your payers and attested. Includes: Profile built and documents uploaded; Payers authorized to view it; First attestation. | $250 per clinician |
| Credentialing: one insurance plan One clinician with one insurance plan, from application to effective date. Includes: Application filed; Follow-up every 2 weeks until decided; Contract review checklist (rates, timely filing, termination); Effective date confirmed and loaded in your EHR. | $175 per plan |
| Medicare enrollment (PECOS) Medicare enrollment for an individual clinician, with reassignment to your group. Includes: PECOS application; Reassignment to the group; Revalidation date tracked. | $350 per clinician |
| Medicaid enrollment State Medicaid enrollment and the first managed care plan. Includes: State enrollment (Texas: TMHP); One Medicaid managed care plan; Revalidation date tracked. | $350 per clinician |
| Facility or group contract: one plan A program or group contract with one insurance plan: the organization application, site visit and contract. Includes: Organization application; Site visit preparation if the plan does one; Contract and rate review checklist; Effective date and billing set-up confirmed. | $450 per plan |
| Credentialing upkeep We keep every clinician's credentials current, every month. Includes: 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. | $49 per clinician a month |
How long each plan takes
Typical days from a complete application to in network, from our payer directory. The calculator uses the same ranges. Some plans are faster and some take longer, and a closed panel can mean no at any speed; we tell you which plans in your area are open.
| Plans | Typical time | Reads CAQH |
|---|---|---|
| Commercial plans Aetna, Cigna / Evernorth Behavioral Health, UnitedHealthcare / Optum Behavioral Health, Blue Cross and Blue Shield of Texas | 45–120 days | Yes |
| Medicare (PECOS) | 30–90 days | No |
| Medicare Advantage plans Humana (Medicare Advantage), Medicare Advantage plans | 60–120 days | Yes |
| Texas Medicaid (TMHP) | 30–60 days | No |
| Texas Medicaid and CHIP managed care plans Superior HealthPlan, Wellpoint Texas (formerly Amerigroup), Molina Healthcare of Texas, Community Health Choice and 9 more | 60–120 days | Yes |
| Marketplace plans Ambetter (marketplace), Oscar Health (marketplace) | 60–120 days | Yes |
| Behavioral health managers Magellan Healthcare, Carelon Behavioral Health (formerly Beacon Health Options) | 60–120 days | Yes |
| Employee assistance and benefit networks ComPsych (EAP), Lyra Health, Spring Health | 30–90 days | No |
| TRICARE and VA Community Care TRICARE, VA Community Care Network | 60–120 days | No |
Because of these timelines, many clinicians open with self-pay clients and add each plan on its effective date. Claims for a plan's members before that date usually deny. Our readiness review works out the weeks to your first client, insurance included.
The order to file in
- NPI first (and the organization NPI for a practice), with the taxonomy that matches the license.
- Gather the packet once: licenses, the IRS letter with your EIN, a W-9, the malpractice declarations page, a CV with month and year for every job, and a voided check for direct deposit.
- CAQH next. Build it, upload the documents, authorize your plans to see it and attest it; in our roadmap this takes about a week once the packet is ready.
- File every commercial plan together right after CAQH is attested, and follow up every two weeks (sooner when a plan asks for more).
- Medicare in PECOS, with each clinician's billing reassigned to the practice. LPCs and LMFTs can enroll since January 1, 2024 (CMS).
- Texas Medicaid through TMHP, then each managed care plan in your service area, because most Texas Medicaid clients are in managed care. Texas Medicaid plans share one credentialing verification organization through the Texas Association of Health Plans (TAHP). LPCs and LMFTs need Medicare enrollment before Texas Medicaid enrollment, since March 2024, unless the pediatric exemption applies (BCBSTX Medicaid notice).
- Review each contract before signing: the rates for your codes, the timely filing limit, termination terms and the effective date. Then load each effective date and provider ID into your EHR.
Programs differ: a Texas SUD program applies as a facility only after its HHSC license is issued, and each facility contract takes about three months. The guide to starting an IOP in Texas covers that sequence, and the IOP / PHP Program Launch ($24,500) includes 8 facility contracts.
The cost of keeping it current
Credentials lapse quietly, and a lapse can drop you from a network. CAQH needs re-attesting every 120 days or plans can't use it; plans recredential about every three years; Medicare revalidates about every five; Texas Medicaid enrollment must be revalidated at least every five years in PEMS, and HHSC suggests filing at least 120 days before the due date (HHSC). Every address, phone or roster change also has to reach every plan. 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
Do it yourself or pay for it?
- Do it yourself if you're one clinician joining two or three plans, you're organized with documents, and you can make the follow-up calls during business hours. Start with CAQH, keep a log of every reference number, and call every two weeks.
- Pay for it when you're adding several clinicians or plans at once, when Medicaid managed care is involved (two steps per clinician), when you're opening and the weeks matter, or when an application has already stalled.
- Whoever does it, watch for: a legal name that doesn't match the IRS letter, an expired document in CAQH, a practice address that differs between NPPES, CAQH and the application, and seeing members before the effective date.
- Avoid any arrangement that pays a credentialer or biller a percentage tied to patient volume or referrals without your attorney's review. Our fees are flat for that reason.
Want it handled, plan by plan?
We build your CAQH profile, file each plan complete, follow up every two weeks and confirm the effective date in writing. Start with a free 30-minute call about which plans to pick.
Questions
How much does credentialing cost per insurance plan?
With us, $175 per plan for one clinician with one plan, from application to effective date, including follow-up every two weeks. A program or group contract is $450 per plan.
Is CAQH free?
Yes, a CAQH ProView profile is free for providers. Building it takes time: every license, policy, address and work history entry, plus uploads and the attestation. We build it for $250 per clinician.
How long does credentialing take?
Usually 60 to 120 days per plan once the application is complete. Medicare and TMHP enrollment are often quicker; Medicaid managed care plans come after TMHP, so plan on the two steps back to back.
Can I see a plan's members while my application is pending?
Not as in network: claims before the effective date usually deny. See them as self-pay with a good faith estimate, or, for a program, ask the plan for a single case agreement in writing before admission.
Does a group need to credential each clinician separately?
Usually yes: the group gets its contract and each clinician is credentialed and linked to it. Our Group Practice Launch ($7,500) includes 2 clinicians with 5 plans each; each added clinician is $750, credentialed with 5 plans.
Can you guarantee I'll get into a network?
No one honestly can. Each plan decides, and some panels are closed in some areas. We make sure each application is complete the first time and tell you plainly when a plan says no and what to try next.
Sources
- Cima Consulting's price list, payer directory and Texas launch roadmaps (prices, typical days and the filing order on this page)
- NPPES; CAQH ProView; Medicare PECOS; TMHP; IRS: get an EIN
- CMS, Marriage and family therapists and mental health counselors in Medicare
- Texas Association of Health Plans, Credentialing 101 (fall 2024)
- BCBSTX Medicaid, Medicare enrollment required for LPCs and LMFTs (May 2024)
- HHSC, Texas Medicaid provider revalidation
Cima Consulting isn't a law firm; contract and referral questions belong with your health-care attorney.
Ask us about your plans
Tell us your license, your area and the plans your clients carry. We'll reply within one business day with which are open and what it would take.
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