Resources
Plain-language guides to insurance credentialing, payer enrollment, CAQH (DataSpring), Medicare, and reimbursement rates.
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
In network but no patients? 9 reasons and fixes
Credentialed but getting no referrals: lapsed CAQH, missing directory listings, the wrong program or NPI code, and how to check each one.
How much does credentialing cost in 2026?
Real published prices per application, per provider, monthly and percentage-of-claims, the hidden costs to ask about, and a worked example.
Credentialing deadline laws by state
Which states give insurers 30, 60 or 90 days to decide, which mandate CAQH, and which pay you while you wait. Every rule cited.
Medicaid managed-care plans by state
Every Medicaid MCO in the 42 states and DC that use managed care, with membership and how to join each one.
How long does insurance credentialing take?
Realistic timelines payer by payer - Medicare vs. commercial vs. Medicaid - and what actually causes the delays.
CAQH (DataSpring) profile setup, explained
What CAQH (DataSpring) is, why every commercial payer reads from it, and the 120-day re-attestation cycle that quietly stalls applications.
Medicare / PECOS enrollment help
The 855 forms, PTANs, revalidations, and why Medicare goes first - it allows retroactive billing.
Credentialing for nurse practitioners
NP-specific requirements - collaborating-physician documentation, independent-practice states, and payer quirks.
Credentialing for PT, OT and speech-language therapists
Medicare private-practice enrollment, the assistant question, Medicaid billing vs. ordering-only status, and the commercial therapy networks (Optum Physical Health, ASH) that need their own applications.
Negotiating higher reimbursement rates
When a fee schedule is negotiable, what leverage looks like, and the break-even math on trying.
DME supplier Medicare enrollment (CMS-855S)
Accreditation, the surety bond, fingerprints and the site visit, revalidation every three years, and the 2026 moratorium that has now ended.
Insurance credentialing for therapists
LCSW, LPC, LMFT and psychologists: CAQH (DataSpring), the 2024 Medicare change for counselors, Medicaid, and the behavioral health carve-outs.
Free Tools
Medicare Revalidation Date Lookup
Enter an NPI to see the revalidation due date CMS has posted for each enrollment, and what to do next.
Is My Credentialing Application Stuck?
Check your state's legal deadline for a payer decision, see if it has passed, and get a follow-up letter to send.
In Network but No Patients?
Answer a few questions about one plan and see the most likely reasons members are not reaching you, with the fix for each.
State Guides
Medicaid programs, Medicare contractors and the dominant commercial plans differ by state. Every state has its own page; a few of the most requested are below.
New York · Pennsylvania · Florida · Texas · California · Illinois · Ohio · Georgia · Massachusetts · North Carolina · All 50 states and DC
Credentialing and payer enrollment in New Jersey
NJ FamilyCare through NJMMIS, the five Medicaid MCOs, Horizon, Aetna, UnitedHealthcare, AmeriHealth and Medicare through Novitas, with realistic timelines.
How to join the Horizon BCBSNJ network
CAQH (DataSpring) first, the participation request, the credentialing committee, Horizon NJ Health and Braven Health, and the reasons applications stall.
New Jersey Medicaid provider enrollment, explained
State enrollment versus MCO credentialing, risk levels and fingerprinting, revalidation, and what each step typically takes.
Payer Guides
Aetna · UnitedHealthcare · Cigna · Humana · Anthem · Optum Behavioral Health · Medicare Advantage plans · All payers
Have a question these don't answer? Ask directly - or check a live application with your reference number on the status page.