Physician Credentialing
What Physician Credentialing Services Cost
Real market pricing for physician and psychiatrist credentialing: what the ranges mean, what’s actually included at each level, and exactly what we charge.
Compare Credentialing Packages Ask Practice ConciergeFirst, Three Things People Mix Up
If you searched for physician credentialing cost, the results probably blended three different things. They aren’t the same, and they don’t cost the same.
Board certification is your specialty board. Exam fees, MOC, CME. That’s between you and ABPN, ABIM or whichever board applies.
Hospital privileging is a facility granting you the right to admit and treat there. The hospital medical staff office runs it, and it’s usually free to you.
Payer credentialing and enrollment is getting an insurance company to accept you as a participating provider so your claims pay in network. That’s what this page prices, and it’s the one that decides whether you can bill.
What The Market Charges
Per-Payer, Admin-Only: Roughly $150 To $500 Per Plan
You pay per application. Someone fills out the paperwork and submits it. Follow-up is often limited or billed separately, and the count adds up fast: five commercial payers at $400 is $2,000, and that’s before Medicare or Medicaid. It works if your history is clean and you’re willing to chase status yourself.
Full-Service, Managed: Roughly $2,500 To $5,000 Per Physician
A firm owns the whole cycle for you. Most also charge ongoing maintenance, commonly $100 to $250 a month, covering CAQH/DataSpring re-attestation reminders, license renewals, and the three-year recredentialing cycle most payers run. This is the normal range for a physician going out with a full commercial panel.
The catch with both models is that the published number is rarely the final number. Ask what happens when a payer closes a panel, when your application sits for ninety days, or when a name or address change forces a refile.
What AdvanceAPractice Charges
Our prices are published. Which one applies depends on where the payer relationship starts, which providers are included and the payer paths you pick in the builder.
$500 Per Payer, Per Provider: Move Existing Payer Contracts To A New Practice Or Tax ID
You’re already credentialed and you’re moving to a new practice or a new Tax ID. Payer contracts are tied to the credentialed practice and its Tax ID, so they don’t follow you on their own when you incorporate. Moving each one is $500 per commercial payer, per provider, for payers one through five.
$600 Per Payer, Per Provider: New Provider Credentialing & Contracting
You’re joining a clinic that already holds a signed contract with each payer you pick. It’s $600 per commercial payer, per provider, for payers one through five, and that covers the enrollment, roster, affiliation or linkage work each payer needs.
$800 Per Payer, Per Provider: Direct Payer Contracting & Credentialing
Your practice is formed, you have an EIN and a Type 2 NPI, and you need your own contracts rather than a spot on somebody else’s. Up to five commercial payer applications.
$6,000 Flat, Or Six Payments Of $1,000: First Practice Launch
You’re newly licensed and opening your own practice. This isn’t a credentialing package. It covers the business setup and identifier work, five commercial payers to a written effective date, portals and EFT and ERA, EHR selection and setup, scheduling and billing configuration, and ninety days of unlimited questions.
Eligible commercial payers six through nine are $350 each per provider in the same engagement, or the complete payer-six-through-ten block is $1,500 per provider. Each Medicare, Medicaid, or separately administered Medicaid managed-care enrollment path is $500 per provider and may be purchased without a commercial payer.
What Waiting Actually Costs
Credentialing commonly runs 60 to 120 days per payer. The payers and the state control that clock, not whoever you hire, and the bigger expense is usually the months of a fully staffed schedule you can’t bill in network, far more than the fee.
Run your own numbers on the credentialing delay cost calculator before you decide the cheapest option is the cheapest option.
Common Questions
How Long Does Physician Credentialing Take?
Plan on 60 to 120 days per payer. Some payers move quickly and some sit for months. We file complete applications, track each one, and tell you where every payer stands. Nobody can promise you an approval date, and you should be skeptical of anyone who does.
Can I See Patients While I Wait?
You can see cash-pay patients and, with some payers, you may be able to bill retroactively to an effective date once approved. That varies by payer and by contract, and it isn’t something to assume. We’ll tell you which of your payers allow it before you build a schedule around it.
What Makes Physician Credentialing Cost More Than A Nurse Practitioner?
Usually it doesn’t. The work is driven by your history rather than your credential: multi-state licensure, gaps in work history, name changes, prior malpractice claims, and hospital affiliations all add applications and follow-up. A clean single-state file is a clean single-state file.
Who Completes The CAQH Attestation?
You do. We’re added as your authorized practice manager, and we keep your CAQH practice data, locations, identifiers and re-attestation dates current. You complete and attest your own profile. We never ask for your password.
Is Doing It Yourself Viable?
For one or two payers with a clean history, yes. It’s tedious more than hard. It stops being viable at five payers across multiple portals, each with its own status process and its own reasons for going quiet, while you’re also trying to open or run a practice.
When Does The Work Start?
In-scope work begins within three business days after onboarding is complete. The clock starts when your completed information and required documents are received, not on the day you sign.
Where To Go Next
Every price above is published on the packages and pricing page. For the physician view of the work, see physician credentialing services. For what happens after you’re on the panels, see medical billing for physicians. State-level program detail lives in credentialing and payer enrollment by state.
Next Step
Know What This Would Cost For Your Practice.
Every service has a published price and a written scope. If you are not sure which one fits, ask and you will be pointed at the right one.