Service
Provider Credentialing & Payer Enrollment Services
Credentialing and payer enrollment services for individual providers, groups, and facilities — including CAQH maintenance, re-credentialing tracking, and revalidation support.
Overview
What credentialing and enrollment cover.
Credentialing and payer enrollment are what allow a provider to bill an insurance plan — until they are complete, claims for that provider are denied or cannot be submitted at all. LRx Healthcare manages enrollment for individual providers, groups, and facilities: building and maintaining CAQH ProView profiles, preparing payer applications, following up until each provider is active, and tracking re-credentialing and revalidation dates so enrollment never lapses.
We keep credentialing tied to billing. New-provider start dates are coordinated with enrollment status so visits are not billed under a provider who is not yet active with that payer, and enrollment problems found in denials are routed back to credentialing. For the full process, documents, and timelines, see our provider credentialing guide.
What you get
What’s included.
- Initial payer enrollment and contracting support
- CAQH ProView setup and ongoing maintenance
- Re-credentialing tracking and reminders
- Medicare and Medicaid revalidations
- Group, facility, and individual NPI workflows
Outcomes
What better looks like.
- Fewer enrollment delays
- Cleaner provider data across payers
- No missed re-credentialing windows
- Faster onboarding for new providers
How it works
How enrollment is managed.
- 1
Provider data
Licenses, DEA registration, board certification, malpractice coverage, work history, and NPI details are gathered once and kept current.
- 2
CAQH ProView
The CAQH profile is created or updated, documents are uploaded, and the profile is re-attested every 120 days as CAQH requires.
- 3
Payer applications
Applications are prepared for each commercial, Medicare, and Medicaid plan you want to join, including group and facility enrollment where needed.
- 4
Payer follow-up
Each application is followed up by phone and portal, with reference numbers documented, until the provider is approved and loaded.
- 5
Effective dates
Approval, effective date, and provider ID are recorded for every payer, so billing starts on the right date.
- 6
Revalidation & re-credentialing
Medicare revalidation (every five years for most providers) and each payer’s re-credentialing cycle are tracked, with submissions prepared before the deadline.
- 7
Ongoing maintenance
New locations, address changes, and expiring documents are updated with payers and CAQH so provider data stays consistent everywhere.
What we need from you
- Provider documents: licenses, DEA, board certification, malpractice certificate, and CV
- NPI numbers and any existing payer IDs
- CAQH ProView login, if a profile already exists
- The payers you want each provider to be in network with
- Practice tax ID and location details
What you can track
- Status of every application, by provider and payer
- Effective dates and payer IDs once approved
- Upcoming CAQH re-attestation, revalidation, and document expiration dates
- Items waiting on your team
Related services
Often paired with this service.
Most providers see the biggest gains when these workflows are operated together.
Credentialing guides
Free guides on this topic.
Practical, answer-first guides from the LRx Healthcare revenue cycle team.
Credentialing FAQ
Common questions about this service.
Quick, direct answers to the questions providers ask most about LRx Healthcare.
Let's get started
Ready to upgrade your credentialing workflow?
Request a free consultation or billing audit and we’ll walk you through where this service fits in your revenue cycle.