Maintaining accurate and up-to-date credentialing, payer enrollments, hospital privileging, and provider licensing are essential to unlocking the revenue your pediatric practice needs to thrive and continue providing high-quality care for children. These critical administrative tasks — often complex and time-consuming — can directly impact your bottom line through delayed reimbursements and potential compliance risks.
Our end-to-end services are tailored to reduce this burden, minimizing errors and preventing costly deactivations that could lead to rejections, denials, lost revenue, and even the loss of privileges. With our proactive approach and expertise in pediatric-specific regulations, you can maintain a consistent revenue stream and have peace of mind knowing your credentialing and enrollments are done right – the first time.
Don’t let complex and confusing forms or changing payer rules slow you down. Instead, imagine a world without the endless paperwork, compliance anxiety, and delayed payments. That’s where our Credentialing & Enrollment Services team comes in.
Hear from a pediatric practice administrator who shares how partnering with OP lifted the burden of credentialing and enrollment, creating a trusted, confident partnership.
Tell us a little about yourself, and we’ll get you scheduled for a discovery call with an OP expert.
We simplify the credentialing, enrollment, privileging, and provider licensing processes so that you can focus your time on other important tasks.
Getting started is easy!
We'll schedule a brief consultation to understand your practice's unique credentialing needs and challenges.
Based on our assessment, we'll develop a tailored plan to optimize your credentialing and enrollment processes.
Our expert team handles all the paperwork, follow-ups, and ongoing maintenance, freeing up your valuable time.
Discover how OP Credentialing and Enrollment Services reduced the enrollment and credentialing process time by 50% for one pediatric practice, and how our team can do the same for yours! Plus, enjoy the added bonuses of:
A: Provider credentialing is the process of verifying a healthcare provider’s qualifications, education, training, licensure, and background to participate in insurance networks and hospital systems. It’s critical because without proper credentialing, you cannot bill insurance companies for your services, leading to delayed revenue and potentially lost income. Credentialing typically takes 90-120 days and must be maintained with regular updates and re-credentialing cycles.
A: The credentialing timeline varies by payer and situation. Initial credentialing with commercial insurance companies typically takes 90-120 days, while Medicare and Medicaid enrollment can take 60-90 days. Hospital privileging may take 90-180 days depending on the facility’s committee meeting schedules. Our OP Credentialing team has helped practices reduce these timelines by up to 50% through proactive application management, complete documentation, and strategic follow-up with payers.
A: If credentialing expires, you risk immediate termination from insurance panels, meaning you cannot bill those insurers for services—resulting in significant revenue loss. Claims may be denied, requiring patients to pay out-of-pocket or forcing you to write off charges. Re-credentialing after a lapse is often more difficult and time-consuming than maintaining active status. Our proactive monitoring ensures your credentials never lapse, with automated alerts for renewals, license expirations, and re-credentialing deadlines.
A: Yes, each insurance company requires separate enrollment applications, and each may have different requirements, forms, and verification processes. For pediatric practices, this often includes multiple Medicaid programs (each state manages their own), various commercial payers (Blue Cross, United Healthcare, Aetna, etc.), and CHIP programs. Our team manages all these enrollments simultaneously, ensuring complete documentation and timely submission to every payer relevant to your practice.
A: Typical credentialing requirements include: current medical license (state-specific), DEA certificate, board certification documentation, CV with complete work history, proof of malpractice insurance (with specific coverage amounts), professional references, education transcripts (medical school and residency), National Provider Identifier (NPI), CAQH profile (Council for Affordable Quality Healthcare), hospital privileges (if applicable), and sometimes additional state-specific documentation. Our team manages all documentation collection, verification, and submission on your behalf.
A: Our credentialing and enrollment services are priced based on your specific needs—whether you’re onboarding a new provider, maintaining current credentials, or managing re-credentialing. Investment varies by the number of payers, complexity of your situation, and whether you need hospital privileging. We provide transparent quotes and demonstrate ROI by calculating the revenue you would lose during delays or denials versus the investment in our expert services. Many practices find the service pays for itself by preventing just one month of billing delays.
A: While it’s possible to handle credentialing in-house, it’s extremely time-consuming and complex, especially for busy pediatric practices. Common challenges include understanding varying payer requirements, tracking multiple deadlines across different insurers, managing incomplete applications that cause delays, responding to verification requests promptly, and staying current with changing regulations. Most practices find that the time their staff spends on credentialing (often 10-20 hours per provider per month) is more costly than our service, and errors or delays can cost thousands in lost revenue.
A: CAQH (Council for Affordable Quality Healthcare) ProView is a centralized database where healthcare providers store their credentialing information. Most insurance companies use CAQH to verify provider credentials, making it essentially mandatory for participating in commercial insurance networks. Your CAQH profile must be continuously updated (every 120 days minimum) to remain active. Our team manages your CAQH profile maintenance, ensuring it’s always current and complete, which accelerates the credentialing process with all participating payers.
