Built for independent, group, and multi-location practices
Medical Practice Credentialing & Payer Enrollment
Move providers from document collection to active payer participation without placing applications, portal work, and follow-up on your clinical team.
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Medical Practice Credentialing & Enrollment
Credentialing confirms qualifications. Enrollment places approved providers and entities into payer systems for participation and payment. Contracting may also be required to establish network terms.
Credentialing
We organize and validate the professional and practice information payers use to assess participation.
- Licenses, education, training, and certifications reviewed
- NPI, taxonomy, CAQH, and demographic data aligned
- Work history, malpractice coverage, and disclosures organized
- Sanctions and exclusion sources checked as applicable
- Payer-specific credentialing files prepared
Without Credentialing:
- Applications can be returned for missing or conflicting data
- Network participation and effective dates may be delayed
- Referral and directory visibility may be affected
- Recredentialing gaps can interrupt participation
Enrollment
We coordinate the applications and setup needed to connect clinicians, groups, locations, and payment records to selected payers.
- Individual, group, and location applications coordinated
- Commercial, Medicare, and Medicaid workflows supported
- Application references, responses, and status tracked
- Directory and roster details reviewed after approval
- EFT, ERA, EDI, and reassignment steps coordinated
Without Enrollment:
- Claims may reject or process outside the intended network
- Payments can be delayed by incorrect group or banking setup
- Providers may not appear correctly in directories
- Billing teams may spend more time resolving preventable issues
What Changes When You're In-Network?
Network participation affects patient access, referral visibility, billing workflows, and the predictability of reimbursement.
Stronger Revenue
Participate in the plans your patients use and reduce avoidable out-of-network billing.
Wider Reach
Make your clinicians easier to find through accurate payer directories and network listings.
Verified Standing
Present current, validated professional information to plans, referral partners, and patients.
Lighter Admin Load
Move applications, portal work, and payer follow-up away from clinical and front-desk teams.
Higher Approval Odds
Review each file against payer requirements before submission to reduce preventable rework.
Always Compliant
Track profile attestations, licenses, rosters, and recredentialing dates before they lapse.
Credentialing for Different Medical Practice Types
We adapt the application sequence to your specialty, entity structure, locations, clinicians, and target payer networks.
PCP
Primary Care Practices
Practice-specific credentialing & enrollment
SP
Specialty Practices
Practice-specific credentialing & enrollment
MG
Multi-Specialty Groups
Practice-specific credentialing & enrollment
BH
Behavioral Health Practices
Practice-specific credentialing & enrollment
UC
Urgent Care Centers
Practice-specific credentialing & enrollment
ASC
Ambulatory Surgery Centers
Practice-specific credentialing & enrollment
TH
Telehealth Practices
Practice-specific credentialing & enrollment
FQHC
Community Health Centers
Practice-specific credentialing & enrollment
MSO
MSOs & Provider Networks
Practice-specific credentialing & enrollment
You Treat Patients. We'll Handle the Rest.
From provider files to payer follow-up, keep the administrative workload with a team built for credentialing and enrollment.
Zero risk to start
You Pay Only After Approval
No onboarding fee, no monthly retainer, no surprise line items. Our invoice arrives after your file is approved.
Numbers we stand behind
A 95% Approval Rate
More than 15,000 clinician files have cleared review with us. Every document is checked twice before submission.
Earn what the work is worth
Rate Negotiation Included
Getting listed is only half the job. We benchmark local fee schedules and push for the strongest contract you qualify for.
Hands fully off
End-to-End Paperwork
Data entry, portal uploads, roster edits & endless follow-up calls all sit with MantraComply team.
Momentum from week one
Faster Turnaround
Clean first submissions and direct payer contacts keep your file moving instead of sitting in a queue.
A person, not a portal
One Named Specialist
You get a direct line to the person handling your file — no ticket numbers, no repeating your history.
From Practice Review to Active Payer Enrollment
Four coordinated stages move your providers and locations from planning through payer activation and maintenance.
01
Build Your Enrollment Strategy
We analyze your specialties, locations, payer mix, and growth goals to identify the health plans worth prioritizing.
- Practice and payer-mix review
- Network gap identification
- Priority health plan mapping
- AI-assisted enrollment roadmap
02
AI-Powered Application Prep
We gather & organize your credential while AI checks every application for completeness, accuracy, & payer requirements.
- Credential collection and verification
- AI-powered application checks
- Payer-specific formatting & validation
- Human review before submission
03
AI-Verified Submission
Applications are automatically tested, validated, and submitted to prioritized health plans—helping reduce errors, and avoid rework.
- AI-tested applications before submission
- Simultaneous multiple submissions
- Priority routing where available
- Weekly status tracking and follow-ups
04
Activate, Monitor & Scale
Once you’re approved, we help close the final gaps, keep your payer information accurate, and prepare your practice for growth.
- Contract and fee-schedule review
- Provider directory verification
- Billing and EDI/ERA setup
- Ongoing re-credentialing support
Medical Practice Credentialing Requirements Checklist
Collect a complete source file once, then tailor it to each payer’s current requirements.
Professional Credentials
Licensed qualifications & certifications
Professional license (current and valid)
Ensure expiration is 6+ months out
Educational transcripts and diplomas
Official transcripts from registrar required
Board certifications
Include all specialty certifications
DEA registration (if applicable)
Required for prescribing providers
Controlled substance licenses
State-specific requirements vary
CAQH profile (completed and current)
Must be updated within 120 days
Identity & Background
Personal identification and verification documents
Government-issued photo ID
Driver’s license or passport
Social Security card or verification
Original document required
Background check authorization
Criminal and sanctions screening
Professional references (3-5)
Include contact information
OIG/SAM exclusion verification
Automated monthly monitoring available
Disclosure questionnaire
Complete all sections thoroughly
Practice & Insurance
Business documentation and liability coverage
Malpractice insurance certificate
Coverage requirements vary by payer and state
Business license and tax ID
State and federal registration required
CV/Resume with complete work history
No gaps in employment/training
Hospital privileges (if applicable)
Current affiliation letters
Office lease or ownership documents
Practice location verification
National Provider Identifier (NPI)
Individual and group NPIs if applicable
*Requirements vary by payer, state, provider type, and practice structure.
Choose the Right Credentialing Solution for Your Medical Practice
Use a managed administrative model or retain direct ownership of payer contracts and revenue.
Join Mantra's Managed Model
Credentialed under Mantra. We manage insurance administration for you.
It includes:
Free credentialing and enrollment with 50+ health plans
Mantra manages billing, claims, credentialing, & payer administration
Access our negotiated payer rates
We disburse payments within 20 business days of receiving them from the insurer
Get client referrals from Mantra
Your Practice, Your Name
Keep your payer relationships and revenue. Pay Mantra credentialing & enrolment services.
It includes:
Your enrollments & payer contracts stay in your practice name
100% of payer revenue is paid directly to your bank account
Pay an annual agreement fee, billed monthly as per the published rate card
Optional billing / RCM support for a fee
Get Access to Credentialing & Enrollment Software
Why Choose Us for Medical Practice Credentialing & Enrollment?
Free or Independent — Your Choice
Get credentialed for free through Mantra or maintain your own practice with paid services.
Dedicated Recognition Specialist
One named lead owns your file end to end, so your staff never has to chase a payer for status.
Automated AI Maintenance
AI-powered re-credentialing & license renewal tracking— so you never miss a deadline.
95% First-time approval rate
AI-powered validation ensures accurate, complete submissions—reducing errors, follow-ups, & delays.
75% Turnaround time reduction
Automation cuts manual data entry and accelerates credentialing process from submission to approval.
Compliance Tools
CAQH Re-attestation reminders, Medicare Advantage, CMS & multi-state / telehealth support.
Medical Practice Payer Credentialing
We support applications with applicable commercial plans and government programs based on provider eligibility, location, specialty, and network availability.
*Payer availability and participation requirements vary by state, plan, and provider type.
Medical Practice Billing & Revenue Cycle Management
Extend support beyond enrollment with billing and RCM workflows designed to connect payer setup, clean claims, remittance, denials, and follow-up.
Adaptive
Insurance Claim Submission
Prepare and submit claims using the payer and billing details established during enrollment.
Compliant
Eligibility & Benefits Verified
Check coverage and benefit information before care to reduce avoidable patient and claim issues.
Compliant
Payment & ERA/EOB Mgmt.
Match remittance information to expected reimbursement and identify discrepancies.
Collaborative
Denial Management
Identify denial causes and coordinate corrections, resubmissions, or appeals.
Transparent
Accounts Receivable Follows
Monitor unpaid claims and follow up on aging balances with payers.
Reliable
Payer Follow-Up
Resolve claim-status, demographic, payment, and enrollment-related questions.
Continuous
Credentialing-to-Billing
Carry approved enrollment details into billing setup and claims workflows.
Proven
Revenue Cycle Support
Support billing operations after enrollment so practice teams can focus on care.
Things Medical Practices Ask Us First
Answers to common questions about provider credentialing, payer enrollment, maintenance, and cost.
How long does medical practice credentialing take?
Timing depends on the payer, provider type, state, network availability, and whether the submitted file is complete. Many processes take several weeks or months, and no third party can control a payer’s review time. We prepare the file, track responses, and follow up through the payer’s process.
What documents are required for medical practice credentialing?
Common items include provider licenses, NPIs, education and training history, a current CV, malpractice coverage, work history, practice locations, tax information, ownership disclosures, and CAQH information where used. Exact requirements differ by payer and provider type.
Does a medical practice need a CAQH profile?
Many commercial health plans use CAQH to collect provider data, but not every payer or provider type does. Participating providers generally need accurate, current profiles and periodic re-attestation. We help set up, review, and maintain applicable profiles.
Can you credential a medical practice with multiple insurance companies?
Yes. Applications can be coordinated across selected commercial plans and government programs, subject to each plan’s eligibility rules, network status, and participation requirements.
Do all providers in a medical practice need to be credentialed with insurance companies?
Requirements vary by payer, clinician type, employment or contracting arrangement, and billing model. We review the practice roster and determine which individual, group, location, and reassignment steps each payer requires.
Can you help with Medicare enrollment for a medical practice?
Yes. We can support eligible practices and clinicians with PECOS applications, reassignments, location changes, ownership updates, and related enrollment records. Medicare requirements depend on the entity and transaction involved.
Which states does MantraComply support?
MantraComply supports credentialing, payer enrollment, and licensing workflows across all 50 U.S. states, including California, Texas, Florida, New York, New Jersey, Pennsylvania, Illinois, Ohio, Georgia, North Carolina, Michigan, Arizona, Colorado, Virginia, Washington, and more, along with Washington, D.C., and U.S. territories. Our workflows are tailored to the licensing, payer, and compliance requirements of each jurisdiction.
Do you provide support after credentialing, including billing, claims, recredentialing, etc.?
Yes. MantraComply can support your practice beyond initial credentialing and enrollment. Depending on your service plan, support can include payer follow-up, enrollment monitoring, re-credentialing, roster updates, EFT/ERA setup, and ongoing compliance tracking.
For practices using Mantra’s managed model, the broader service can also include billing, claims, payer administration, and insurance operations, creating a more end-to-end workflow from credentialing through reimbursement.
How much does medical practice credentialing cost?
Pricing depends on the number of providers, locations, payers, specialties, and whether the practice needs initial enrollment, updates, recredentialing, or ongoing support. We provide a scoped quote after reviewing your practice.
Get Credentialed Through Mantra — Your Way
Choose the model that works best for your medical practice. Join the Mantra network for free credentialing and end-to-end insurance support—or stay independent and use our paid credentialing and RCM services.
- No upfront fees
- 95% success rate
- 30 days average enrollment
- Dedicated credentialing specialist
- End-to-end billing & insurance support
Start Your Medical Practice Credentialing Journey
Tell us about your practice and get a free consultation on the best credentialing and enrollment option for you.
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