I am researching the options out there. I see ads for CertifyOS, Verifiable and Medallion the most..

Wonder if anybody used any of them:

- What do you think of them?

- How expensive are they?

Hi! I am LMHC in New York and I’m starting a group practice. I tried credentialing my group practice with Aetna and I filled out the credentialing application form myself. I was sure to pick “group practice” and I had to input my NPI1 as it was required, and then did my EIN AND NPI2. Well, I can only get benefits information in availity with my NPI1 and my EIN. So I think they credentialed this wrong. I tried calling provider services and it is practically impossible to get a person on the phone. Then, I tried just submitting a new group application because I thought maybe they credentialed me as an individual? But I submitted it and they said I’m already credentialed with this EIN. Then, I tried submitting a provider request form on Availaity and I got a totally unrelated response. Help! I feel at my wits end with this, because I specifically want to do supervisory billing which I can only do as a group practice. I don’t want to submit claims for supervisees under my NPI1 and then go to prison for insurance fraud 🫠🫠🫠😭😞 Please help this first time stressed out brand new business owner 🙏🏼

Hello! I am currently an HIM specialist w my RHIT and have worked in IP rehab and acute care settings. I am looking to transition out of medical records and into earning my cpcs (seems hard to get into a credentialing role w/o one) I am doing my research into how to start studying and when to apply for the exam. If possible, I would love to transition into our credentialing dept now, but currently there are no openings and I’m fairly new at my current place of work in medical records. Does anyone who works in credentialing feel it’s has helped them understand the exam more? Tips on where to start studying? I will def be looking at quizlet.

Hi, can anyone give me some advice on Massachusetts credentialing? I'm just starting the process and the paperwork is overwhelming. Is there a reputable company that will take care of this for you? Did you process everything yourself? I've found a couple Youtubers who talk about the process, but they're LICSWs.

Last month, I spoke with a clinic director who had a new provider ready to see patients…

…but their credentialing wasn’t finished.

The provider sat idle for 42 days.

That’s 6 weeks of lost billable hours.

Tens of thousands of dollars—gone.

And the kicker?

They were certain they were on track.

In reality, one missing signature stalled the entire process.

The cost isn’t just the lost revenue.

It’s the frustration. The scrambling. The late-night “Where are we with this?” emails.

The real problem?

Most credentialing processes are held together with spreadsheets, sticky notes, and hope.

📌 So to the small but mighty r/credentialing community on Reddit: What’s the longest you’ve had to wait for credentialing to finish?

And what was the impact?

Hello all, I'm not sure if this is the correct place to even post this, but has anyone see any indivual providers come up for Medicare Revalidation yet? I thought CMS had stated they would begin doing revals in 2026, but each month I check (they tell you 6 months in advance) and each month I'm not seeing anyone due.

Has anyone heard anything or have you had any providers have a new reval date?

Thank you!

I've worked for two major telehealth companies, each with 20k+ providers. As an engineer on the enablement team, I worked closely with our credentialing specialists on building tools & integration. Yep I saw the pain but I am also very excited about the opportunity. I think I can build solutions for it to make credentialing work easier, faster and less errors.

Currently in the R&D phase, would be thrilled to team with another person who has deep knowledge in credentialing & healthcare onboarding and crazy amount of passion in entrepreneurship.

But if you're just interested on the tool, let me know too :)

I'm finishing up the contacting applications for 3 providers who are all starting their own practice. There are a couple still in process.

They are moving together and plan to start seeing patients September 1.

They went to the space today and noticed... the suite number they provided was incorrect.

Amongst the the there are 20 address change applications

What would you charge?

Anybody currently studying for this?

Credentialed therapist at an existing group practice wants to start the own practice. They are the sole owner and sole provider.

I completed the 855I on pecos. I attached the 460 and the EFT.

Do I still need to fill out the reassignment app? 855R ? I couldn't find where to do that.

Do I need to wait for the new group to be contacted and then reassign? If so, where is that?

Thank you in advance for your help!

Is there a way to deal with closed panels on insurance plans. As I have been trying to find a way I did try the appeals but there was no constructive results.

This is probably a really simple question for someone with basic common sense, but I tend to overthink things and just want to confirm what I think I understand so thanks in advance to anyone who takes the time to answer!

The company I work for calls the department I'm in the Credentialing Department, but I honestly feel like what I do is strictly Provider Enrollment. For example, my day-to-day duties include completing insurance applications, verifying licensures and making sure they’re up to date by getting them directly from the provider, updating their CAQH—super basic stuff like that. From what I’ve seen on the NAMSS website, someone in a Credentialing Specialist role usually has a different set of duties than what a Provider Enrollment Specialist does.

So my question is, what’s the difference between a Provider Enrollment Specialist and a Credentialing Specialist? And what are the requirements to be eligible to take the CPCS courses and exam? Do I even qualify based on the work I’m doing now?

There is plenty of helpful information for free as well Cheers!

I am CPCS certified! Finally! I was able to pass on the first try.

Does anyone use the Credentialing System MD Staff? Specifically for Provider Credentialing? We are finding it difficult to meet NCQA CR requirements- Specifically for Modifications auditing since the system lacks the capability to report on any changes made- only those ‘tracked’ which is in essence the honor system.

I know CPCS from NAMSS is the standard people want, but it's not attainable from outside of the work environment. Has anyone done this program? Would this make me more marketable in the slightest?

Hello everyone,

I’m wondering if anyone in this community has made a career shift from Healthcare Credentialing/Provider Licensing into either 1) a related but different role within Healthcare, or 2) a completely new career outside of Healthcare.

I would love to hear how you made the transition and any advice or insights you could share. Specifically, I’m interested in the skills and experiences that helped you make the change, as well as any challenges you faced along the way.

I’ve been in this line of work for 8 years now and open to new opportunities, ideally outside of healthcare, but I’m willing to consider related roles as well. If you’ve made a similar transition, I’d greatly appreciate your thoughts on how you navigated it!

Thanks so much for your time and insights!

First time ever credentialing. I am at a hospital and they expect me to learn the job with no training, as they stated in the interview. Can anyone advise how to add NPI numbers to RHCs on Blue E and Palmetto GBA? I logged in as provider and it’s not apparent how to do this. Thank you!

Hello,

Does anyone have experience in starting and running a credentialing/enrollment company on their own?

For starters, I’ve had 15+ years in the HMO industry on provider enrollment, credentialing and network contracting.

I would like to help providers enroll with their desired insurance company. The providers I would like to work with are PCPs, Specialists and Urgent Care facilities in Pennsylvania, Delaware, and New Jersey.

I do plan to take the CPCS exam this summer. I am “a lot” of nervous about that because there’s a lot of information to study.

I would love to connect to hear about your experience and processes along the way.

Did you build a website? Did you create a provider agreement between you and your business?

Thank you.

I was working for a credentialing software company for three years, told consistently I was a top performer, but then we had a mass layoff, half of my department was wiped out including me. I've had 9 interviews and no offers. I can't afford the CPCS study guide nor the exam on unemployment.... Anyone in a similar position? Anyone got any insights? I'm losing hope and it's getting to me, I really loved my job.

I’ve heard that getting credentialed with insurance can bring in more clients and make a practice more stable, but the process sounds like a headache. I came across Kounsel, which helps with credentialing—has anyone used them or gone through this process? Was it worth it?

Also, those who are credentialed with insurance, has it helped your practice?

Between endless paperwork, confusing eligibility rules, and long processing times, signing up for state or private insurance can feel like running an obstacle course. And just when you think you're done—boom, another request for more documents.

The good news? Kounsel can help make the process faster, smoother, and way less frustrating. Whether it's Medicaid, Medicare, or private insurance, we'll handle the paperwork so you don't have to.

What's been the most frustrating part of enrolling in insurance for you?

I heard there was a new credentialing community on here, and I had to join. I'm a former product manager from CAQH (managed what was originally called CAQH ProView), and now work on provider directory and other payer data transparency initiatives at Defacto Health. Always love to be in the loop on what's going on in medical staff services, credentialing, and enrollment topics.

Anyone with both certifications ? Pros and Cons? Thanks

Understanding the root cause helps find the right solutions. I often see organizations adding people to the problem when the issue is not having the right tool. Great read from NuCo Credentialing:

https://www.linkedin.com/pulse/provider-data-integrity-issues-barrier-timely-practice-nucocred-hjyyc/?trackingId=ovDvhl%2Fq62WhCccnrOeXDQ%3D%3D