Services
Medical Credentialing Services for Practices in Florida and Nationwide
Medicare lets you bill back at most 30 days before your effective date (90 after a declared disaster), and that date is never earlier than the day you file. Our medical credentialing services cover initial enrollment and credentialing with commercial health plans, Medicare and Medicaid, the follow-up on each application, and the recredentialing and revalidation that come after.
The short answer
What do medical credentialing services include?
Every application a payer needs before it pays your providers. Plans publish timelines from 14 days to up to 90, most counted only from a complete application, and Medicare pays only enrolled providers, so file early. The Advixor Group handles initial enrollment and credentialing with commercial plans, Medicare and Medicaid, follows up each application, and keeps recredentialing and revalidation current.
Our Services
What our medical credentialing services cover
The package covers one tax ID (EIN) and up to five providers; more providers or tax IDs are billed on our fee schedule (what credentialing costs). Payers decide acceptance, timing and rates, and we don’t guarantee them.
Medical credentialing services
For each provider, we handle:
- Initial provider enrollment and credentialing with commercial health plans, Medicare, Medicaid and other applicable payers
- Preparation, submission, monitoring and follow-up of each credentialing and enrollment application
- Payer contracting assistance: applications, participation agreements and negotiation support
- NPPES/NPI registration and maintenance, and enrollment in payer portals and credentialing systems
- Recredentialing, revalidation and payer roster updates
- Demographic updates, provider additions, terminations and other payer-required changes
Provider or Payer
Which provider credentialing services fit your case
Start from the provider (physician credentialing services, NPs, therapists, specialties) or the payer (insurance credentialing services with Medicare, Medicaid and commercial plans).
| Your case | File or gather first | One fact to plan around | Where it’s covered |
|---|---|---|---|
| Physicians (MD, DO) | Hospital privileges, or a signed hospital coverage arrangement | Cigna doesn’t accept temporary or pending privileges | Hospital and specialty credentialing |
| NPs, APRNs and PAs | Autonomous registration or a protocol; AHCA Form 5000-1067 unless autonomous | Medicare pays 85% of the physician amount under their own NPI | NP and PA credentialing |
| Therapists and counselors (LCSW, LMHC, LMFT) | NPI and CAQH profile, then each plan’s behavioral network | LMHCs and LMFTs bill Medicare in their own name since January 1, 2024, at 75% | Mental health credentialing |
| Behavior analysts (BCBA, BCaBA, RBT) | BACB certification; Florida Medicaid provider type 39 | Florida is not among the 41 jurisdictions that license or regulate behavior analysts | ABA credentialing |
| Other specialties (PT, OT, chiropractors, labs, telehealth) | Florida license, CLIA certificate (labs) or Florida telehealth registration | A CLIA certificate lasts no more than 2 years | Specialty credentialing |
| Medicare | NPI, then the CMS-855I or PECOS (CMS-855B for a group) | PECOS rejects an application whose request for information sits unanswered 30 days | Medicare enrollment |
| Florida Medicaid | AHCA application in FLMMIS: Full, Limited or ROPA | A Medicaid plan can’t pay you, even out of network, without a Medicaid ID | Florida Medicaid enrollment |
| Commercial plans | A CAQH profile each plan may view, then each plan’s own application | Humana left employer-group commercial medical plans in 2025 | Payer enrollment |
| CAQH (DataSpring) | Registration at proview.caqh.org, plan authorizations, attestation | Re-attest every 120 days, or the profile expires the next day | CAQH and NPI |
| Recredentialing and maintenance | One calendar of CAQH, plan, Medicare and Medicaid dates | 60 calendar days to answer Medicare’s revalidation request | Recredentialing |
Sources each linked page and its official sources, read Oct 17 to 20, 2026.
Documents
What documents are needed for provider credentialing
Most plans ask for:
- an active license;
- DEA and state CDS registrations;
- board status and training;
- five years of work history;
- a malpractice face sheet;
- hospital privileges or a coverage agreement;
- a W-9 matching the tax ID;
- the NPI and a CAQH ID the plan may view.
Gaps need an explanation: CAQH asks about every gap over 6 months in the past 10 years. Each plan’s version, malpractice limits included, is in our physician credentialing checklist; run exclusion checks before you file.
Verification Windows
How fresh physician credentialing documents must be
Verifications count back from the plan’s decision.
The checklist lists the NCQA and Humana window for every document.
- 120 daysHumana accepts a license verified within this window.
- 180 daysThe window at NCQA-accredited organizations.
- 120 daysDataSpring rejects an attestation form signed more than this long before upload, so sign it close to filing.
Sources Humana policy; NCQA guide (Sept 2025); CAQH user guide v46.0 (June 2026).
Plan Timelines
Published insurance credentialing timelines
Chapters 627 and 641 of the Florida Statutes set no credentialing deadline for commercial insurers or HMOs and no rule that they pay for visits before the effective date; 42 CFR 422.204 and 438.214 set no deadline for Medicare Advantage or Medicaid plans.
Every plan’s clock, with Medicare’s and Florida Medicaid’s, is in our credentialing timeline chart.
- A complete applicationMost plans’ clocks start only here.
- 14 daysThe shortest published, in UnitedHealthcare’s FAQ.
- Up to 90 daysThe longest: Evernorth, for its whole joining process.
Sources UnitedHealthcare FAQ (Oct 14, 2026); Evernorth.
Approval
When provider credentialing ends and in-network visits can start
Each payer marks the end its own way: Cigna emails the approval with your effective date, UnitedHealthcare sends a denial in writing with appeal information, and Humana lists a provider in its directory only after credentialing, which it completes before the contract’s effective date. Medicare starts from enrollment itself.
“To receive payment for covered Medicare items or services from either Medicare … or a Medicare beneficiary (in the case of an unassigned claim), a provider or supplier must be enrolled in the Medicare program.”
Adding a Provider
How to credential a provider who joins your group
- A group contract does not skip credentialing. UnitedHealthcare onboards every clinician who joins a practice already under its agreement before they see members in network; Aetna wants a separate application for each provider in a group.
- File on the plan’s clock. UnitedHealthcare’s October 14, 2026 FAQ says to submit no more than 30 days before the clinician’s start date.
Before You Hire
Choosing among credentialing companies
Ask any credentialing company what it will own, and for how long.
- Medicare and Medicaid, or only commercial plans?
- The CAQH profile and NPI records, or only the applications?
- The years after approval? Florida Medicaid renews every 5 years (3 for institutional and out-of-state providers), and plans recredential on their own cycles.
In this section
Credentialing cost
How much does credentialing cost? What is free (NPI, CAQH, Medicare for practitioners), what is not, the cost of delays and how our pricing works.
Learn moreMental health credentialing
Mental health credentialing services for LCSWs, LMFTs, LMHCs and psychiatric providers: commercial plans, behavioral networks, Medicare, Medicaid.
Learn moreNP and PA credentialing
Nurse practitioner credentialing services: Florida autonomous practice or protocols, CAQH, Medicare, Medicaid and commercial plans for NPs and PAs.
Learn morePayer enrollment
Payer enrollment services: how to get credentialed with insurance companies, published plan timelines, and contracts through to an effective date.
Learn moreCAQH and NPI
CAQH credentialing: your Provider Data Portal profile (formerly ProView, now DataSpring) set up and ready for each 120-day attestation, plus your NPI.
Learn moreMedicare enrollment
Medicare provider enrollment in PECOS: CMS-855I and CMS-855B filings, effective dates, PTAN, opt-out and revalidation.
Learn moreFlorida Medicaid enrollment
Florida Medicaid provider enrollment through AHCA: full, limited or ROPA enrollment, SMMC plan credentialing in Region I, and renewals.
Learn moreRecredentialing
Recredentialing and credentialing maintenance: CAQH re-attestation, 36-month recredentialing, Medicare revalidation and Florida Medicaid renewal.
Learn morePayer contracting
Insurance contract negotiation services: participation agreements, fee schedules and the terms beyond the rate, with legal review by your attorney.
Learn moreOther specialties
Credentialing companies for hospitals and other specialties: privileges, PT and OT, chiropractic, telehealth, labs and Florida's 30-day privileges rule.
Learn moreABA credentialing
ABA credentialing services in Florida: BACB certification, Florida Medicaid behavior analysis enrollment and commercial plan applications, followed up.
Learn moreQuick answers
Hiring medical credentialing services: what practices ask
Outsourcing, short assignments, license checks, a provider's rights and where we work. Bring anything else to a consultation.
Why do practices hand credentialing to an outside team?
Does a provider who works fewer than 60 days need full credentialing?
How do I check a new provider's license before we apply?
What rights does a provider have during credentialing?
Do you work only with Miami and Florida practices?
Talk to an advisor
You care for patients. Who’s taking care of the business?
Tell us where your practice is today. We will tell you what we would do first.
Official sources
All read Oct 17 to 21, 2026.
- eCFR, current as of Oct 15, 2026: 42 CFR 422.204, 424.505, 424.520, 424.521, 424.522, 438.214
- Florida Statutes (2026): s. 409.966, chapters 627 and 641
- CMS, Program Integrity Manual, ch. 10 (Rev. 13717, July 8, 2026), §10.6.2(C), and Jurisdiction N
- AHCA, Provider Enrollment Policy (Feb 2026), §2.6.1 and §6.1
- Cigna; UnitedHealthcare network page and FAQ (Oct 14, 2026); Humana policy; Florida Blue manual (Sept 2026); Evernorth; Aetna join page and FAQs
- NCQA credentialing guide (Sept 2025); CAQH user guide v46.0 (June 2026); MGMA Stat poll (Nov 2025)