Fast-Track Your Provider Credentialing and Enrollment

Provider credentialing is the gateway to getting paid. Until your providers are credentialed and enrolled with insurance payers, your practice cannot submit claims through our medical billing services -which means no revenue, regardless of how many patients you see.

Hiba MD’s provider credentialing and enrollment service handles the entire process from initial application through ongoing maintenance, so your providers can focus on patient care while we handle the paperwork.

Why Credentialing Is Critical

For new practices, credentialing is the single biggest bottleneck between opening your doors and generating revenue. For established practices adding new providers, a credentialing delay means:

• Weeks or months of seeing patients without being able to bill their insurance
• Retroactive billing limitations that vary by payer and are easy to miss
• Revenue loss that can total $20,000-$50,000+ per provider per month of delay
• Patient access issues when uncredentialed providers cannot accept certain insurance plans

The credentialing process is notoriously complex, with each payer requiring different forms, different documentation, and different timelines. A single error or missing document can add weeks to the process.

Our Credentialing Services

CAQH ProView Profile Management

CAQH ProView is the industry-standard credentialing database used by most health plans. We handle:

• Initial profile creation with complete and accurate data entry
• Document uploads including licenses, certifications, and insurance certificates
• Quarterly attestations to keep your profile current and active
• Re-attestation reminders to prevent profile deactivation

A well-maintained CAQH profile speeds up enrollment with every payer that uses the system.

Medicare PECOS Enrollment

Medicare enrollment through the PECOS (Provider Enrollment, Chain, and Ownership System) portal has its own set of requirements and challenges:

• Individual and group enrollment applications (CMS-855I, CMS-855B)
• Reassignment of benefits to your group practice
• Medicare specialty updates and changes
• Revalidation when Medicare requires it (typically every 5 years)

Commercial Payer Panel Enrollment

We manage enrollment with all major commercial insurance payers:

• Blue Cross Blue Shield (all regional plans)
• UnitedHealthcare / Optum
• Aetna / CVS Health
• Cigna / Evernorth
• Humana
• State Medicaid programs
• Regional and specialty payers specific to your area

Each payer has unique application requirements, and we know exactly what each one needs to process your application without delays.

NPI Registration

Every healthcare provider needs a National Provider Identifier (NPI) to bill insurance. We assist with:

• Type 1 NPI registration for individual providers
• Type 2 NPI registration for group practices and organizations
• NPI updates when practice information changes
• NPI deactivation when providers leave a practice

Re-Credentialing & Maintenance

Credentialing is not a one-time event. Most payers require re-credentialing every 2-3 years, and credentials like state licenses, DEA certificates, and malpractice insurance have their own renewal schedules.

We track every expiration date and manage renewals proactively:

• Automated expiration tracking for all licenses and certifications
• Re-credentialing applications submitted well before deadlines
• CAQH attestation reminders every 120 days
• Payer roster updates when practice information changes

The Hiba MD Credentialing Advantage

Our dedicated credentialing team processes applications daily. This means:

• Fewer errors because our team knows each payer’s requirements by heart
• Faster turnaround because applications are complete and accurate on first submission
• No missed deadlines because we track every credential and renewal date
• Simultaneous submissions to all targeted payers, not one at a time

Typical Credentialing Timelines