Credentialing
Credentialing companies for hospitals and other specialties: PT, chiropractic, telehealth and labs
Hospital credentialing companies assemble the file, but the hospital's governing body decides, and a Florida hospital or surgery center that denies privileges to a physician, dentist, podiatrist, APRN or PA, among others, must give its reasons in writing within 30 days of the applicant's written request (s. 395.0191(6), F.S.). We prepare hospital privileges applications and credential physical and occupational therapists, chiropractors, telehealth practitioners and labs with Medicare and health plans.
The short answer
What do hospital credentialing companies do?
They assemble the privileges file; the hospital's governing body decides. CMS surveyors expect each file to hold at least a request for privileges, current licensure, training, documented experience and references on competence, and the hospital queries the National Practitioner Data Bank when you apply and every 2 years after. The Advixor Group prepares, submits, monitors and follows up each application.
Sources42 CFR 482.12CMS State Operations Manual, App. A45 CFR 60.17
Provider Types
What hospital credentialing companies and experts prepare, and what the hospital decides
We prepare, submit, monitor and follow up each application (how our credentialing works); each provider type starts somewhere else:
| Provider type | First step | Medicare enrollment | Renewal cycle |
|---|---|---|---|
| Hospital medical staff | Privileges under the medical staff bylaws | Separate: the physician’s own CMS-855I | Reappraisal: CMS recommends at least every 24 months |
| Physical and occupational therapists | Florida license (ch. 486; ch. 468, part III) | CMS-855I as a therapist in private practice (specialty 65 or 67) | Plans: 36 months; Medicare: 5 years |
| Chiropractors | Florida license (ch. 460) | CMS-855I as a physician (specialty 35) | Plans: 36 months; Medicare: 5 years |
| Out-of-state telehealth | Florida registration (s. 456.47) | A home office “for administrative/telehealth use only” if it is the only location | Humana may recredential more often than every 36 months |
| Clinical labs | A CLIA certificate | Independent labs: CMS-855B with each location’s CLIA certificate; $750 fee in 2026 | CLIA certificate: 2 years |
| Surgery and imaging centers | Accreditation or a plan site visit; an ASC also needs an AHCA license | Accreditation for advanced imaging (42 CFR 414.68) | Plans: at least every 36 months |
Sources 42 CFR parts 410, 414, 424 and 493; CMS manuals; s. 456.47, F.S.; plan documents; read Oct 20, 2026.
What the hospital decides
Under Medicare’s hospital rules, the governing body decides who may apply and appoints members after the medical staff examines each candidate’s credentials. CMS’s surveyors expect each file to hold at least a request for privileges, current licensure, training, documented experience and references on competence (State Operations Manual, A-0341).
The governing body must also
“Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.”
Florida Law
The hospital credentialing process under Florida law
Florida’s privileges statute, s. 395.0191, covers hospitals and ambulatory surgical centers (ASCs):
- A qualified MD, DO, dentist, podiatrist or practitioner licensed under chapter 490 can’t be denied solely because of the license chapter.
- APRN and PA applications get their own rules, and an APRN can’t be denied solely for the license or for not joining the Florida Birth-Related Neurological Injury Compensation Plan (NP and PA credentialing).
- A PA’s privileges end automatically when the supervising physician’s staff membership ends.
- Every denial is reported in writing to the applicant’s licensing board.
The medical staff reviews every appointment and reappointment and, except in emergencies, recommends withdrawing privileges only after “a thorough investigation,” with a hearing on request (Rule 59A-3.275). The hospital queries the National Practitioner Data Bank when you apply and every 2 years after (45 CFR 60.17). Physicians licensed under chapter 458 (MDs) who hold staff privileges, or perform surgery in a licensed ASC, must carry at least $250,000 per claim and $750,000 a year in coverage, escrow or a letter of credit; subsection (5) lists exemptions (s. 458.320).
Health Plans
Hospital credentialing requirements the health plans check
Cigna, UnitedHealthcare, Aetna and Humana each take admitting privileges at a participating hospital or an admitting arrangement; Florida Blue asks for privileges “if applicable.” UnitedHealthcare applies the rule only when your practice requires admissions. Plan by plan: Cigna, UnitedHealthcare, Aetna, Humana, Florida Blue.
Telemedicine
Telemedicine credentialing across state lines and hospital walls
- Hospitals by proxy. Under a written agreement, a hospital’s medical staff may rely on a distant-site hospital’s or telemedicine entity’s credentialing and privileging decisions if, among other conditions, the practitioner is privileged there and licensed or recognized in the hospital’s state, and adverse events and complaints are sent back (42 CFR 482.22(a)(3)-(4)).
- Florida registration. An out-of-state professional with an active, unencumbered license, no discipline in the 5 years before applying, a Florida registered agent and Florida-level liability coverage may register to treat Florida patients by telehealth (form DH5037-MQA). Registrants can’t open an office or see patients in person in Florida, must report discipline within 5 business days, and get an approval letter, not a license.
- Plans. Aetna’s virtual-only providers need no physical office but must have referral arrangements with participating providers within 30 minutes of the member.
Physical Therapy
Physical therapy credentialing services and Medicare’s private-practice rules
Medicare pays a therapist who practices privately “on a regular basis” and bills only for services in the practice’s office or the patient’s home; the office must be “owned, leased, or rented by the practice and used for the exclusive purpose of operating the practice” (42 CFR 410.59, 410.60). The CFR, amended in December 2024, lets assistants work under general supervision, while the 2014 Benefit Policy Manual still says direct; assistant services are paid at 85 percent.
The 2026 KX threshold is $2,480 for PT and speech-language pathology combined and $2,480 for OT. UnitedHealthcare sends outpatient therapy providers and chiropractors to its physical-health network administrator.
Chiropractic
Chiropractic credentialing: a narrow Medicare benefit and a different route at each plan
Medicare Part B pays only for a chiropractor’s manual manipulation of the spine to correct a subluxation (42 CFR 410.21(b)). Florida Blue’s participating agreements exclude chiropractors unless they explicitly include them, and Humana credentials them itself.
“Claims without the AT modifier will be considered as maintenance therapy and denied.”
Clinical Labs
Credentialing service for labs: the CLIA certificate comes first
Each of the five CLIA certificates (registration, waiver, provider-performed microscopy, compliance, accreditation) lasts no more than 2 years.
- File the CMS-116 with the state agency.
- Get an emailed fee notice with your ten-character CLIA number.
- Pay on pay.gov.
- Receive the certificate by email.
A waiver lab files its renewal 9 to 12 months before expiration and tells HHS within 30 days of a change in ownership, name, location or director. CMS’s schedule lists $248 for a waiver and $297 for provider-performed microscopy; who pays Medicare’s application fee is on credentialing cost.
UnitedHealthcare wants CLIA certification or accreditation for every free-standing commercial lab; Aetna wants CAP accreditation, high-complexity CLIA status and an onsite board-certified pathologist. Florida has 25,787 non-exempt CLIA labs, 9.0% of the nation’s, and 87.2% of them hold a certificate of waiver (CMS, September 2026).
Facilities
Facility credentialing for surgery centers, imaging centers and hospitals
Plans credential the facility apart from its staff. We also prepare facility credentialing applications for surgery centers and imaging centers.
- 85%UnitedHealthcare checks the license, insurance and sanctions (exclusion checks), and wants accreditation or a site visit passed “with at least 85%”; a facility that fails waits at least six months to reapply, and a CMS or state review no more than three years old can replace the visit.
- 36 monthsFlorida Blue doesn’t use CAQH for facilities, requires ASCs to be accredited and needs an AHCA or CMS survey, or its own site visit, within 36 months.
- 361Florida licenses 361 hospitals with 74,301 beds; accreditation is voluntary for them.
Sources UnitedHealthcare Credentialing Plan 2025-2027; Florida Blue manual (September 2026); AHCA, Hospitals page and licensed hospitals report (Oct 6, 2026).
What’s included
What our hospital credentialing services include
Medicare enrollment
The CMS-855I and 855B, effective dates and revalidation for each provider type Medicare enrolls.
Learn morePayer enrollment
Plan-by-plan applications, rosters and directory listings once licenses and privileges are in place.
Learn moreRecredentialing
Plan recredentialing, Medicare revalidation and the other renewal cycles side by side.
Learn moreAccreditation
Survey readiness for the Joint Commission, AAAHC, ACHC and CARF.
Learn moreCLIA waiver
How a Florida practice applies for and renews a CLIA certificate of waiver.
Learn moreVerify a Florida license
How to look up and verify a Florida healthcare license at the source.
Learn moreQuick answers
Hospital and specialty credentialing: your questions
Short answers on privileges deadlines, Medicare telehealth for therapists, chiropractic X-rays, Florida lab licensing and imaging accreditation. Ask us about anything else in a consultation.
Is there a deadline for a hospital to decide on privileges?
Can physical therapists bill Medicare for telehealth?
Will Medicare pay a chiropractor for X-rays?
Does Florida still license clinical laboratories?
How long does imaging accreditation take?
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 20, 2026.
- eCFR (as of Oct 19, 2026): 42 CFR 410.21, 410.60, 414.68, 482.12, 482.22 and part 493; 45 CFR 60.17
- CMS: State Operations Manual, Appendix A (Rev. 248), Benefit Policy Manual, ch. 15, Therapy Services, Telehealth FAQ (10/8/26), Apply for a CLIA Certificate, CLIA fee schedule, CLIA statistics (September 2026), MLN9658742
- Florida: Statutes (2026) s. 395.0191, s. 456.47 and s. 458.320; Rule 59A-3.275; DOH telehealth FAQs and MQA Annual Report FY 2024-25; AHCA Hospitals and licensed hospitals report (10/6/2026); CS/CS/SB 622 (2018)
- Plans: Cigna credentialing and Hospital Coverage Agreement; UnitedHealthcare Credentialing Plan 2025-2027 and FAQ; Aetna participation criteria and manual; Humana credentialing policy; Florida Blue manual (September 2026)