Payer Enrollment Services: Medicare, Medicaid, $149/Payer

When to outsource payer enrollment

Practices hand off payer enrollment when a payer must list a clinician, group or location before it pays, and nobody on staff has time to file and chase it. Six moments start that work:

• A clinician joins your group. We file the clinician's enrollment and the reassignment of benefits to your group as one filing, because CMS merged the CMS-855R into the CMS-855I.
• You are opening a practice or a new group. We enroll the group itself with Medicare and each state Medicaid program, with EFT set up on the group's own account.
• You moved, added a location or changed ownership. We file the change inside CMS's reporting windows when you tell us in time: 30 days for ownership, location and adverse-action changes, 90 days for the rest.
• A revalidation notice arrived. We file before the due date your Medicare Administrative Contractor (MAC) set, from a complete packet; CMS says the notice comes 90 to 120 days ahead.
• Lab, imaging or DME claims are denied over the ordering clinician. MACs deny those claims without a valid individual NPI for the orderer, so we enroll clinicians who only order on the CMS-855O.
• Payments still route to an old bank account or billing company. We move ERA and EFT enrollment with you, through each payer or the Optum Payer Enrollment Services portal where the payer uses it; our checklist for switching billing companies lists the rest of the handover.

What our payer enrollment service covers, and what you keep

Each enrollment line pairs one clinician or group with one payer and ends at a written effective date. A physician joining your group who sees Medicare and Medicaid patients is two lines: the CMS-855I with reassignment, and the state Medicaid application.

Commercial plan credentialing runs through our insurance credentialing service. Contracting, which sets your rates and terms, is a separate engagement. Our credentialing guide shows how all three fit. State licensing, DEA registration and hospital privileges stay with you.

Where enrollment holds up your revenue, and how we prevent it

Enrollment mistakes surface weeks later as unpaid claims and CO-8 specialty-mismatch denials. Here is where, and what we do.

Can you get a new clinician paid from the first visit?

For Medicare, yes, when the application reaches the MAC before that visit and the MAC approves it. The risk: Medicare sets the effective date at the later of the filing date or the date services began at the location, and billing reaches back only 30 days before that date when circumstances prevented earlier enrollment, so weeks of visits before anyone files can go unpaid. What we do: we build the enrollment map around each clinician's first visit and file ahead of it whenever your packet allows. Held claims still count against Medicare's 12-month filing limit, so our handoff sends the effective date to billing with the approval letter.

Do you enroll NPs and PAs who bill under their own NPI?

Yes. CMS requires enrollment for an NPP who bills under their own NPI and for a supervising physician who bills incident-to services, so incident-to billing waits on the supervisor's enrollment. We file each NP's or PA's CMS-855I with reassignment to your group, confirm the supervising physician is enrolled first, and send commercial panels to our commercial plan credentialing team.

• Unanswered information requests. A MAC may reject an application when its request goes unanswered for 30 days. We answer from your packet and send you only what you alone can supply, with its due date.
• Missed revalidations and unreported changes. Medicare providers generally revalidate every 5 years, DMEPOS suppliers every 3. Our maintenance calendar tracks every due date and change window from day one.
• Claims billed under the wrong group. A clinician who works with two groups usually holds a separate PTAN for each. Our handoff lists each PTAN beside its group and effective date, so claims go out under the right one.

Read the workflow as text

1. Enrollment map — Each clinician, location and payer matched to its filing and start date. Owner: Practice + our team.
2. PECOS access — Authorized Official approves us as Surrogate; signing stays with you. Owner: Authorized Official.
3. Filing signed — CMS-855 and EFT prepared by us, signed by you, sent to the MAC. Owner: Our team + signer.
4. Development answered — MAC requests answered from the packet inside the 30-day limit. Owner: Our team.
5. Effective date — Approval letter received; participation decision made on the CMS-460. Owner: MAC + practice.
6. Billing handoff — Effective date loaded; first Medicare claim goes out. Owner: Billing team.

How we start: from enrollment map to first paid claim

1. Map. You list clinicians, locations, start dates and payers; we name the filing each one needs.
2. Access. Your Authorized Official approves us as Surrogate in PECOS. A Surrogate cannot sign enrollment applications, so signing authority stays with you.
3. Packet. We send one checklist per clinician and group, including the voided check or bank letter for EFT.
4. File. We prepare each application, you sign, and we submit it to the MAC, the state or the plan.
5. Follow up. We answer each information request and report status every 14 days.
6. Hand off. The approval letter, effective date and PTAN go to whoever runs your billing; when that is our full-service billing team, they are loaded before the first claim.

What payer enrollment costs with us

Credentialing & Payer Enrollment costs $149 per payer for each clinician or group we enroll. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet. A new clinician enrolled with Medicare and your state Medicaid program is invoiced as two payers, each after its effective date is confirmed.

Payer and state application fees are not included. Medicare's 2026 application fee of $750 falls on institutional providers and suppliers; physicians, NPPs and their groups pay none. Every tier sits on our full rate card.

What we report on every open enrollment

Our status report arrives every 14 days and lists each clinician-and-payer line with five fields:

• Filed: the day the payer received the application, which CMS counts as the filing date.
• Requests: each information request and the date its answer is due.
• Effective: the date on the approval letter, with the PTAN for Medicare.
• Next action: who owes the next step, our team or your practice.
• Due next: the revalidation or change deadline from the maintenance calendar.

Enrollment for your practice type

• DME suppliers: we file the CMS-855S and track the 3-year revalidation cycle; our DME billing team checks each ordering clinician's enrollment before claims go out.
• Home health agencies: we file the CMS-855A, and our home health billing service confirms the certifying physician is enrolled.
• Imaging centers and labs: we confirm each ordering clinician is enrolled or opted out, because organizational NPIs cannot order.
• Therapy practices: we file therapists in private practice on the CMS-855I and therapy groups on the CMS-855B; see physical therapy billing.
• Mental health practices: we enroll psychologists, clinical social workers, marriage and family therapists and mental health counselors on the CMS-855I; see therapist and counselor billing.

Medicaid enrollment follows each state's own application, and we file it on that state's portal; states must enroll ordering and referring physicians too.

Enrollment terms we put in writing

We cannot make Medicare, a state or a health plan approve an application; the payer decides. What we commit to is the filing, the reporting and when you pay:

• Credentialing & Payer Enrollment: $149 per payer. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet.
• Status updates: every 14 days on every open filing.
• New-Clinician Enrollment (billing clients): Clinicians who join while you're a client get enrollment filed with up to 5 payers each (the payer decides), with no per-payer fee.

We publish client results only with written permission. Until we have them, judge us by the guarantees and the free Deadline Map. Ask for an enrollment quote with your number of clinicians, locations and payers, and we price it per payer.

Common questions

How much do your payer enrollment services cost?

$149 per payer for each clinician or group. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet. Payer and state application fees are extra and go to them. See every price and tier.

How fast can you get a new clinician enrolled and billing?

Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet. The payer sets the rest: for Medicare, CMS requires MACs to process 95% of PECOS applications that need no follow-up within 15 calendar days of receipt, and longer when the MAC needs more information. Medicare's effective date can never fall before the filing date, so we time each filing ahead of the clinician's first visit whenever your packet is complete in time.

What do we pay if a payer denies the enrollment?

Nothing for that payer. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet. The payer makes the decision; CMS can deny an application, for example, when a site visit cannot be performed. We report the stated reason and what refiling would take.

Do we have to use your billing service to buy enrollment?

No. Credentialing & Payer Enrollment is sold on its own at $149 per payer. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet. If another company runs your billing, we send it the approval letter and effective date for each line, and EFT deposits go to your practice's own bank account. Billing terms: Month to month. Leave with 30 days' written notice. No termination fee.

What do you need from our practice?

A list of clinicians, locations, start dates and target payers; each clinician's NPI, license and practice history; ownership and managing-employee details for the group; a voided check or bank letter for EFT; your Authorized Official's approval of our PECOS access; and signatures on each application. We send the checklist at kickoff.

Do you handle ERA and EFT enrollment, including Optum Payer Enrollment Services?

Yes, for every payer we enroll you with. Where a payer routes ERA and EFT through Optum Payer Enrollment Services, we file there under the NPI that payer asks for. That portal covers ERA and EFT only, so network enrollment still goes through each payer or PECOS.

Do you handle credentialing as well as enrollment?

Yes, as two services. Enrollment, on this page, registers each clinician with a payer so claims can be paid. Credentialing verifies qualifications for commercial plans and runs through our credentialing service. Both cost $149 per payer. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet. Contracting, which sets your rates, is a separate engagement.