Our customized physician credentialing services cater to a broad spectrum of healthcare professionals, such as:
For our medical credentialing services, we will be needing the following documents from you:
We know how frustrating slow approvals can be. That’s why we stay proactive, organized, and persistent until your providers are fully credentialed and ready to bill.
Monitor application progress anytime with our online portal.
Cut credentialing time down from months into weeks.
Focus on patient care instead of paperwork.
Below are typical timelines for our insurance credentialing services:
Medicaid (State-Specific Programs)
Bring it down to 50–70 days.
Unlike other healthcare credentialing companies, we do not follow a one-size-fits-all approach. We use a clearly defined, step-by-step credentialing framework as per provider type, specialty, and payer mix:
Step 1: Discovery & Document Collection
Audit your credentials and compile a complete responsive packet.
Step 2: Verification & Application Submission
Submit to PECOS (Medicare), state Medicaid, and commercial health plans.
Step 3: Real-Time Status Tracking
Dedicated dashboard, credential coordinator assigned, and weekly updates.
Step 4: Follow-Up & Committee Representation
Manage all requests, corrections, and committee responses until final approval.
Step 5: Ongoing Compliance & Recredentialing
Automatic alerts before license or certification expiry + annual monitoring.
Manage Medicare enrollment using CMS-855I, CMS-855B, and CMS-855R forms. Complete state Medicaid enrollments such as Medi-Cal and TMHP, keeping billing active and preventing interruptions.
Complete credentialing for UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, and local plans. Handle applications, document requests, and re-credentialing cycles every 2 to 3 years.
Submit the CMS-855S application for Medicare DMEPOS enrollment. Meet National Supplier Clearinghouse requirements and keep correct surety bonds for Medicare payments.
Set up your CAQH ProView profile and upload required documents. Complete attestation every 120 days to support payer reviews for Aetna, Cigna, and Anthem.
Manage your PECOS account and keep enrollment details current. Handle changes in ownership, practice locations, and reassignment so Medicare records stay accurate.
Track revalidation dates across Medicare, Medicaid, and commercial payers. Update your information in PECOS and CAQH to avoid deactivation and costly claim denials.
Prepare and maintain Type 1 and Type 2 NPIs through the NPPES portal. Keep identifiers accurate to support HIPAA billing compliance and reduce claim denials.
Handle hospital appointment and reappointment applications, typically every 2 years. Collect CVs, peer references, malpractice history, and required forms for Medical Staff Offices.
Manage new state license applications, renewals every 1 to 2 years, and CME tracking. Support multi-state licensing through the Interstate Medical Licensure Compact.
Assist with DEA registration and renewals every 3 years. Maintain compliance with the Controlled Substances Act to avoid delays in prescribing authority.
Review payer contracts for UnitedHealthcare, Aetna, Cigna, and BCBS. Negotiate better fee schedules and clearer payment terms to reduce underpayment and disputes.
Verify education, training, licensure, board certification, and malpractice history. Follow NCQA, URAC, and The Joint Commission standards to support approvals and audits.
We track enrollment milestones and confirm payer-assigned effective dates to prevent unbillable services.
Over the past decade, Velentra Health Care has supported healthcare organizations with structured credentialing and payer enrollment services with measurable outcomes:
Timelines vary by payer, but most large commercial insurance companies complete credentialing and contracting within 90–120 days. Smaller or regional plans may take longer due to slower internal processes.
The process has two stages:
Credentialing: The payer verifies licenses, education, work history, and background, then submits the file for committee approval.
Contracting: After approval, the participation agreement is finalized and an effective network start date is assigned.
Commercial insurers do not allow retroactive billing. You may only bill for services provided after your enrollment is active in the payer’s system. Billing out-of-network can result in higher patient responsibility, including potential full self-pay balances.
Yes. We support multi-state credentialing for telehealth providers, locum tenens clinicians, and expanding practices.
Medicare enrollment typically takes 60–90 days, though timelines vary by state. Your effective date is based on when Medicare receives the application, not when it’s approved. This means you can bill for services provided after submission, even if approval comes later. Medicare also allows up to 30 days of retroactive billing prior to the effective date. Rules may vary by state programs and certain commercial payers, including BCBS.
DMEPOS enrollment is more involved and usually takes longer. Applications undergo enhanced review and require an on-site inspection. During the visit, inspectors verify:
Yes. We help groups implement and manage delegated credentialing programs that meet NCQA standards and payer requirements.
A valid place of service is required to begin credentialing. Residential addresses cannot be used as temporary clinic locations. If your practice is under construction or preparing to open, the future clinic address can usually be submitted. Most payers allow applications to be filed up to 30 days before the official opening date. A home address may be listed only for billing or correspondence if a physical clinic address is also included.
Most individual providers must revalidate every five years, though certain high-risk provider types may be required to revalidate more frequently.
Once Medicare issues a revalidation request, you have 60 days to respond. Missing the deadline can result in suspended or revoked billing privileges. If EFT isn’t already on file for a group, it must be submitted during revalidation.
We guide you through everything—from NPI and CAQH setup to being fully credentialed and patient-ready. Ideal for residents, fellows, and newly licensed providers.
Requirements vary by payer and state, but most applications request the following:
Medicare accepts only the IRS CP575 or the IRS 147C letter as valid proof of an Employer Identification Number. No substitutes are allowed.
Yes. You’ll receive regular updates and, when needed, access to a dashboard showing pending items, approvals, and upcoming renewals.
Pricing depends on the number of providers, networks, and whether you need one-time setup or ongoing management. We offer transparent, upfront pricing with no hidden fees. Contact us for a customized quote based on your practice’s needs.
Standardized medical credentialing services designed to support payer approval, regulatory compliance, and revenue cycle continuity.
With 10+ years of experience, Velentra Health Care provides trusted Revenue Cycle Management services for practices, hospitals, and laboratories.
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