Credentialing & Payer Enrollment
for Primary Care Providers
Helping Family Medicine, Internal Medicine, and Pediatric practices navigate Medicare PECOS, Group NPI setup, and commercial payer contracting to launch and grow independent clinics.
Tailored Enrollment for Primary Care
Expert credentialing solutions designed exclusively for primary care providers — from physicians transitioning out of hospital employment to multi-site family medicine groups and federally qualified health centers.
From CAQH ProView & Medicare PECOS (CMS-855I/855B) setup to CLIA waiver integration and PCMH roster alignment — we handle every step so you can focus on patient care.
Navigating the Complexities of PCP Billing & Enrollment
Primary care physicians leaving hospital systems face a maze of new credentialing requirements. Our team navigates CMS group enrollment, value-based care rosters, and closed-panel appeals so you can bill from day one.
Medicare PECOS & 855B Group Enrollment
— Transitioning to a group practice requires strict CMS compliance. We expertly process your CMS-855I (Individual), CMS-855R (Reassignment), and CMS-855B (Group) forms to link your NPIs and establish your Medicare Part B billing rights.Value-Based Care & PCMH Paneling
— Are you leaving money on the table? We help align your credentialing with Patient-Centered Medical Home (PCMH) standards and Accountable Care Organization (ACO) rosters to secure higher reimbursement tiers.CLIA Waivers & Ancillary Services
— If you run point-of-care testing (strep, flu, urinalysis), your commercial payers must formally recognize your CLIA waiver. We update your payer profiles to ensure your ancillary labs are fully reimbursed.Closed Panel Appeals
— Primary care networks are frequently "closed" in saturated cities. We bypass standard rejections by writing aggressive appeal letters that highlight your unique access-to-care benefits (e.g., after-hours care, bilingual staff, or specific chronic care programs).Our credentialing experts know the exact verbiage and workflows required to bypass closed-panel rejections and push your file to approval.
The 4-Step Primary Care Credentialing Process
CAQH & Medical Board Audit
We verify your MD/DO state licenses, DEA registrations, and ABMS board certifications to build an unassailable CAQH ProView profile.
Medicare & Entity Setup
We secure your Group NPI (Type 2), establish your Medicare PECOS record, and execute your EFT/ERA banking enrollments.
Commercial Paneling
We submit applications to regional health plans, Medicaid MCOs, and major commercial networks (BCBS, UHC, Aetna, Cigna, Humana).
E&M Contract Optimization
Once approved, we analyze your allowable fee schedules for core E&M codes (99213, 99214, 99215) and Annual Wellness Visits to ensure profitability.
In-Network Paneling for Major Healthcare Payers
We navigate the complex requirements for the nation's largest medical networks, Medicare MACs, Medicaid MCOs, and Medicare Advantage plans for primary care providers.
Primary Care Credentialing FAQs
Common questions about our Family Medicine, Internal Medicine, and Pediatric credentialing services.
I am leaving a hospital to start a private practice. When should I start credentialing?
Can you credential mid-levels (NPs/PAs) under my primary care group?
Do you help with Medicare Advantage (Part C) credentialing?
What is the difference between credentialing a standard clinic and an FQHC?
Ready to Launch or Grow Your Primary Care Practice?
Stop letting administrative red tape delay your revenue. Let Exp Credentialing Services handle your payer paneling so you can focus on your patients.