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Primary Care & Internal Medicine

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.

Built for primary care physicians, clinic owners, office managers, and credentialing coordinators who need Medicare, Medicaid, and commercial paneling handled correctly so new and growing practices can bill from day one.

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45-60 Days
Avg. Commercial Paneling
98%
First-Time Claim Acceptance
50 States
Nationwide Coverage
100%
CAQH & PECOS Compliance
Who We Help

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.

Family & Internal Medicine — Whether you are transitioning from hospital employment to private practice or growing a multi-site clinic, we manage your complete NPI Type 2 and group payer enrollment.
Pediatricians & Geriatricians — Specialized credentialing navigating the complexities of state Medicaid MCOs (for pediatricians) and Medicare Advantage (Part C) networks (for geriatricians).
DPC, Urgent Care & FQHCs — Unique paneling strategies for hybrid Direct Primary Care (DPC) models, walk-in urgent care facilities, and Federally Qualified Health Centers (FQHCs). We tailor credentialing strategies for DPC and concierge models, walk-in urgent care centers, and federally designated FQHC/RHC clinics to match their unique reimbursement frameworks and PPS/PCMH requirements.
Provider Types:
Family Medicine (FM) Internal Medicine (IM) Pediatricians Geriatricians Hospitalists Urgent Care FQHCs & RHCs DPC Clinics Concierge Medicine MultiPlan / PHCS
Complete PCP Credentialing & Medicare PECOS Enrollment

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.

98%
Accuracy Rate*
45
Avg Days
50
States
Commercial & Medicaid
Payer Coverage
In-Network Paneling for: UHC, Cigna, Humana, Aetna, BCBS, Tricare & Medicare
Starting from $125/application · No hidden fees
Estimated Average Timeline: 45–60 days (vs. 90–120 industry standard)
The Toughest Challenges

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).
We Don't Take No For An Answer

Our credentialing experts know the exact verbiage and workflows required to bypass closed-panel rejections and push your file to approval.

Every Month Without Credentialing:
Depending on visit volume and payer mix, many primary care practices experience $15,000–$25,000 per month in lost revenue for every uncredentialed physician.
Advanced PCP Enrollment Expertise:
CMS-855I/855B/855R Processing
Closed Panel Appeal Letters
Key Capabilities:
PECOS 855B/855I CAQH ProView CLIA Waiver Setup PCMH/ACO Rosters Hospital Privileging Medicare Advantage
Our Process

The 4-Step Primary Care Credentialing Process

1

CAQH & Medical Board Audit

We verify your MD/DO state licenses, DEA registrations, and ABMS board certifications to build an unassailable CAQH ProView profile.

2

Medicare & Entity Setup

We secure your Group NPI (Type 2), establish your Medicare PECOS record, and execute your EFT/ERA banking enrollments.

3

Commercial Paneling

We submit applications to regional health plans, Medicaid MCOs, and major commercial networks (BCBS, UHC, Aetna, Cigna, Humana).

4

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.

Nationwide Coverage for Primary Care Practices

Whether you are opening your first solo practice in Texas or expanding a multi-site family medicine group across the Northeast, we understand the exact payer landscape, Medicaid MCO requirements, and Medicare MAC jurisdictions in every state.

Get Started Nationwide
Insurance Networks

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.

Medicare Part B
Regional MACs
UnitedHealthcare
UHC Commercial & MA
Cigna
Commercial Networks
Humana
Commercial & MA
BCBS
Blue Cross Blue Shield
Aetna
CVS Health
Tricare
Military & Veterans
Medicaid MCOs
State Programs

Beyond Paneling: E&M Fee Schedule Optimization

Getting approved by an insurance panel is only half the battle. We also handle the contracting phase, reviewing your allowable rates for high-volume E&M codes like 99213 (Level 3 Office Visit), 99214 (Level 4), and 99215 (Level 5 Complex Visit). We help group practices leverage their patient volume to negotiate better fee schedules and secure profitable Annual Wellness Visit (AWV) reimbursements.

FAQ

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?

You should start the credentialing process at least 90 to 120 days before your clinic's grand opening. Because you need a new Tax ID, NPI Type 2, and new commercial contracts, early submission is critical to ensure you can bill on day one. Our primary care credentialing services help coordinate this transition smoothly, managing your CAQH ProView setup and Medicare PECOS enrollment to prevent any gaps in insurance paneling.
Yes. We handle the complete credentialing and supervisory linkage for your Advanced Practice Providers, ensuring your group complies with state incident-to billing regulations. Mid-levels must be correctly linked to a supervising MD/DO to prevent claim denials and audit risks. We manage this process across Medicare, Medicaid, and all major commercial panels.
Yes. Being enrolled in standard Medicare Part B does not automatically grant you access to Medicare Advantage patients. We submit specific network applications to ensure you are in-network with UHC, Humana, and BCBS Medicare Advantage plans. Our team manages both the initial contracting and the ongoing re-credentialing cycles to maintain active status.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) have completely different CMS enrollment applications, cost-reporting requirements, and PPS (Prospective Payment System) billing structures. A standard clinic typically enrolls individual providers using standard PECOS forms, whereas FQHC/RHC facilities require complex organizational certifications. We specialize in navigating these federal designations to secure correct reimbursement rates.

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.

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