Provider Credentialing & Contracting

Timelines are set by the payers: Medicare typically takes 60–90 days, Medicaid varies by state from 45–90 days, and commercial payers range from 30–120 days. These timelines begin from the date of application — so starting with a complete, error-free application is critical. Applications returned for errors restart the clock, which is the most common source of preventable delays. EMBS conducts a pre-submission audit on every application to eliminate this risk.

CAQH (Council for Affordable Quality Healthcare) maintains the Universal Provider Datasource — a centralized repository of provider credentials that over 1,000 health plans use as the starting point for credentialing. Most commercial payers require an active, complete CAQH profile before they will process an application. CAQH also requires re-attestation every 120 days; a lapsed profile can delay or halt credentialing applications already in progress. EMBS sets up, populates, and maintains your CAQH profile on an ongoing basis.

This depends on the payer and your specific situation. Medicare does not allow retroactive billing in most cases — services rendered before the effective enrollment date cannot be billed. Some commercial payers allow retroactive billing back to the application date if specifically requested. A few payers offer a provisional or "pending" billing status. We advise each practice on their specific situation and, where possible, file for the earliest retroactive effective date to recover revenue during the enrollment window.

Most payers require re-credentialing every 2–3 years. The process typically involves submitting updated credentials, work history, malpractice information, and sometimes peer references. Additionally, CAQH requires re-attestation every 120 days, and DEA registrations, state licenses, and board certifications each have their own renewal cycles. EMBS maintains a master calendar for every provider and initiates renewals proactively — 90–120 days before each deadline — ensuring you never face a billing interruption due to a lapsed enrollment.

Yes. Telehealth multi-state credentialing is one of our specialties. This involves obtaining or verifying state licensure in each state the provider will see patients (some states have expedited processes through the Interstate Medical Licensure Compact), then completing payer enrollment in each state for each payer. We have completed multi-state credentialing across all 50 states and stay current with the rapidly evolving telehealth parity laws and payer-specific telehealth policies.

EMBS monitors every submitted application and responds to requests for additional information within 24 hours. If an application is returned, we identify the specific deficiency, correct it immediately, and resubmit. Because our pre-submission audit catches most issues before they reach the payer, returns are rare. When they do occur, we escalate immediately and notify you — maintaining full transparency throughout the resolution process.

Absolutely — and most practices don't. The fee schedule in your initial payer contract determines your reimbursement rates for every procedure for years to come, and many initial contracts are significantly below what is negotiable. EMBS reviews your payer contracts against Medicare benchmark rates to identify underpayment risks and advises on which terms to negotiate before signing. Payers are more willing to negotiate at the enrollment stage than after you are already in-network.