Physician Credentialing
What Physician Credentialing Services Cost
Physician credentialing runs roughly $150 to $500 per payer for admin-only filing, or $2,500 to $5,000 per physician for a full-service company, often plus $100 to $250 a month for maintenance. We publish ours. It’s $450, $550 or $700 per commercial payer, per provider, based on where the payer relationship starts.
Compare Credentialing PackagesFirst, 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 company 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.
With both models, 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.
Changing Your Tax ID, Quoted In Writing
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. We quote that work in writing, so ask for a quote.
New Provider Credentialing, $2,750 Per Provider
You’re joining a clinic that already holds a signed contract with each payer you pick. It’s $550 per commercial payer, per provider, for payers one through five, and that covers the enrollment, roster, affiliation or linkage work each payer needs.
Direct Payer Contracting, $3,500 Per Provider
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. It’s $700 per commercial payer, per provider, for up to five commercial payer applications.
First Practice Launch, $6,000 Or Four Payments Of $1,500
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, and scheduling and billing configuration. Questions are part of working with us, during setup and for as long as you’re a client. Send them in the Command Suite or by email, and we reply within one business day, usually the same day. If a question turns into new work, like a new build or a change to something we built, we send a written quote before we start. Pay in full for a 90-day Launch period, or choose staged work across six months on the monthly option. Pay in full and every stage opens right away, and your handoff comes as soon as the work is done.
Add-ons are flat too. Payers six through nine are $350 each, or $1,500 for payers six through ten. Medicare or Medicaid enrollment is $450 each, and you can buy it on its own or with a package. Pay in full and your closeout package comes as soon as the work is done, with no monthly autopay.
What Waiting Costs
Credentialing usually takes 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
Does The Price Change By Specialty?
No. Package prices are set by the payer work, not the specialty. Some specialties need extra steps, like hospital privileges or facility enrollment, and anything outside a package gets a written price before we start.
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 while we work your applications. After that, Credentialing Maintenance keeps it current. You complete and attest your own profile. If you want us to maintain your profile, you share access securely and change the password when we’re done.
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 on the packages and pricing page, where the credentialing price builder shows your itemized total before it asks for your contact details. For the physician side of the work, see physician credentialing services. State program detail is in credentialing and payer enrollment by state.
Not Sure Which Credentialing Package Fits?
Every credentialing package has a published price and a written scope. Tell us what’s changing in your practice and which payers you need, and we’ll point you to the right one.