Medical Credentialing Services for Arizona Providers
Get your providers enrolled with Medicare, AHCCCS and the commercial plans your patients carry, without your office manager chasing payer reps for months. We build the CAQH profile, file every application, follow up every week and tell you the day each provider can start billing.
“Credentialing used to take us six months of chasing. They got four new providers enrolled and billing in nine weeks.”
- CAQH · PECOS · AHCCCSEnrollment through approval
- AlertsBefore any credential lapses
- Medicare, AHCCCS and Commercial Payers
- CAQH Managed for You
- Weekly Status Reports
- HIPAA Compliant
- Arizona-Focused Team
Every Week a Provider Isn't Credentialed Is a Week of Visits You Can't Bill
You hired the provider. The schedule is ready. But until each payer loads them as in-network, those visits either get turned away, sent out of network or written off.
An incomplete CAQH profile
One missing malpractice face sheet or a lapsed attestation, and every commercial application waits.
Applications sent to the wrong place
Payers use different forms for individuals, groups and facilities. Medicare alone has separate CMS-855 forms for each.
No one following up
Applications sit in payer queues for weeks. Without regular calls, nobody notices a request for more information until it has already expired.
Group and individual records that don't match
A provider is approved, but not linked to your group TIN or service location, so claims still deny.
Missed renewals
CAQH re-attestation, Medicare revalidation and payer recredentialing all have deadlines. Miss one and a provider can drop out of network overnight.
We take that whole job off your desk, from the first NPI to the last effective date.
Credentialing Handled by People Who Also Bill Your Claims
Most credentialing companies stop at the approval letter. We are a billing company, so we keep going until the first claim for that provider is paid. That is the only result that matters to your practice.
We know Arizona's payer map
Which AHCCCS plans need separate credentialing, which commercial panels are closed for your specialty in which county, and who to call when an application stalls.
One specialist per provider file
You always know who is working your application, and so does the payer rep.
Weekly status reports
Every application, its stage, the last contact with the payer and the next step, in one report you can read in two minutes.
Effective dates we can bill against
We confirm the effective date, the provider ID and the group linkage in writing, then load them into your billing system so claims go out clean from day one.
Nothing lapses
CAQH attestations, license and DEA expirations, Medicare revalidation and payer recredentialing are tracked on a calendar we own.
Month-to-month
No long-term contract. Stay because the work gets done.
Adding a provider soon? Get a Free Credentialing Review and a realistic start-billing date.
Every Credentialing and Enrollment Service Your Practice Needs
Physician Credentialing Services
Credentialing for MDs and DOs with every payer you choose, including primary source verification of license, board certification, education and work history.
Provider Enrollment (Medicare and Medicaid)
Medicare enrollment in PECOS using CMS-855I, CMS-855B and CMS-855R reassignment, plus AHCCCS registration through the AHCCCS Provider Enrollment Portal (APEP).
Insurance Credentialing (Commercial Payers)
Applications, follow-up and participation agreements with Blue Cross Blue Shield of Arizona, UnitedHealthcare, Aetna, Cigna, Humana and Medicare Advantage plans.
CAQH ProView Setup and Maintenance
We build the profile, upload documents, grant payer access and re-attest every 120 days so applications never stall.
Nurse Practitioner and PA Credentialing
Enrollment for NPs, PAs and other advanced practice providers, including billing under their own NPI or incident-to arrangements where payers allow.
Behavioral Health Credentialing
Psychiatrists, psychologists, LPCs, LCSWs, LMFTs and LISACs credentialed with AHCCCS plans, Medicare and commercial behavioral health networks.
Group and Facility Enrollment
New group NPIs, TIN linkage, new locations, ASCs, urgent care, labs and DMEPOS suppliers.
Recredentialing and Revalidation
Payer recredentialing cycles, Medicare and AHCCCS revalidation, and roster updates when providers join, move or leave.
Hospital Privileges
Initial appointment and reappointment packets for medical staff offices.
Licensing, DEA and CSPMP
Arizona license applications and renewals, DEA registration and Arizona CSPMP registration for prescribers.
Payer Contracting
Fee schedule review, contract questions and requests for rate updates when contracts come up for renewal.
New Practice Setup
NPI Type 1 and Type 2, CAQH, Medicare, AHCCCS, commercial payers, ERA and EFT enrollment, and clearinghouse setup for a practice opening its doors.
Credentialing With the Payers Arizona Patients Actually Use
Your patients carry Medicare, AHCCCS, Medicare Advantage and a handful of big commercial plans, and each one has its own forms, portals and timelines. We credential you with the payers that match your patient mix, in the order that gets you billing soonest. Here is who we work with every week.
| Payer group | Who we credential with | What to know |
|---|---|---|
| Medicare | Noridian Healthcare Solutions (Jurisdiction F) through PECOS | Medicare lets you bill up to 30 days before your filing date once approved, so filing early matters |
| AHCCCS (Arizona Medicaid) | AHCCCS registration through APEP, then each AHCCCS Complete Care plan: Mercy Care, Banner University Family Care, Arizona Complete Health, UnitedHealthcare Community Plan and others | AHCCCS registration and plan credentialing are separate steps, and each plan has its own timeline |
| Commercial | Blue Cross Blue Shield of Arizona, UnitedHealthcare, Aetna, Cigna, Humana, Banner|Aetna | Some panels close by specialty and county; we request exceptions when your area is underserved |
| Medicare Advantage | UnitedHealthcare, Humana, Aetna, Wellcare and other MA plans | Often credentialed separately from the commercial product of the same carrier |
| Military and veterans | TriWest for TRICARE West and VA Community Care | Separate network applications and agreements |
| Workers' comp | Industrial Commission of Arizona and workers' comp networks | Useful for orthopedics, occupational health and therapy practices |
Arizona Medical Board, Arizona Board of Osteopathic Examiners, Arizona State Board of Nursing, Arizona Regulatory Board of Physician Assistants, Arizona Board of Behavioral Health Examiners, Arizona Board of Psychologist Examiners, Arizona Board of Chiropractic Examiners, Arizona Board of Physical Therapy, Arizona State Board of Optometry and the Arizona State Board of Pharmacy for CSPMP registration. For facilities, we coordinate with Arizona Department of Health Services (ADHS) licensing.
Medical Credentialing Services for Providers of Every Type
| Provider type | Credentials we handle |
|---|---|
| Physicians (MD, DO) | All specialties, including primary care, cardiology, orthopedics, oncology, radiology, anesthesiology and surgery |
| Nurse practitioners | Family, adult, pediatric, psychiatric (PMHNP) and acute care NPs |
| Physician assistants | Primary care and specialty PAs, including supervision or collaboration details payers ask for |
| Behavioral health clinicians | Psychiatrists, psychologists, LPC, LCSW, LMFT, LISAC and BCBA |
| Therapists | Physical, occupational and speech therapists |
| Other licensed providers | Chiropractors, podiatrists, optometrists, dietitians, audiologists and CRNAs |
| Organizations | Group practices, behavioral health agencies, ASCs, urgent care, labs, DMEPOS suppliers, RHCs and FQHCs |
Practice Sizes
Solo providers opening a first office, small groups adding one or two clinicians a year, and multi-location groups onboarding providers every month. You pick the providers and payers, and we scope the work to match.
Service Area
Phoenix, Tucson, Mesa, Scottsdale, Chandler, Gilbert, Glendale, Tempe, Peoria, Flagstaff, Yuma, Prescott and rural Arizona. We also credential out-of-state providers moving to Arizona or registering to offer telehealth to Arizona patients.
How Our Provider Credentialing Process Works
Free credentialing review
We look at each provider's current enrollments, CAQH status and the payers you want, then give you a realistic plan and start-billing date.
Document collection
You get one checklist and a secure upload link. We chase the missing pieces so you don't have to.
Profiles and IDs
We set up or fix NPPES, CAQH ProView and PECOS records so every application pulls the same, correct data.
Applications filed
Medicare, AHCCCS and each commercial payer get the right form for an individual, a group or a facility.
Weekly follow-up
We call and check portals every week, answer requests for more information the same day, and log every contact.
Approval and contract
We confirm the provider ID, effective date, group linkage and fee schedule in writing.
Billing setup
ERA and EFT enrollment, clearinghouse setup and provider IDs loaded into your practice management system so the first claim pays.
How Long Does Medical Credentialing Take?
Payers set the clock, not us. These are typical ranges we see in Arizona. We shorten them by filing complete applications and following up every week.
| Step | Typical time |
|---|---|
| NPI (NPPES) | A few days to 2 weeks |
| CAQH ProView setup | 1 to 2 weeks, depending on documents |
| Medicare (PECOS through Noridian) | 45 to 90 days |
| AHCCCS registration (APEP) | 4 to 8 weeks |
| AHCCCS Complete Care plans | 60 to 120 days after AHCCCS registration |
| Commercial payers | 60 to 120 days, sometimes longer |
| Hospital privileges | 60 to 180 days |
Start 90 to 120 days before a new provider's first day whenever you can.
What You'll Need for Physician Credentialing
Have these ready and most applications can go out in the first two weeks. Missing one? Tell us and we'll help you get it.
For each provider
- Current Arizona license and any other state licenses
- DEA registration and Arizona CSPMP registration, if the provider prescribes controlled substances
- Board certification, or board eligibility details
- CV with month and year for every position, and a short note for any gap over six months
- Diplomas, residency and fellowship certificates, and ECFMG certificate for international graduates
- Malpractice certificate of insurance (face sheet) and 10 years of claims history
- Individual NPI and CAQH ProView login, if one exists
- Government-issued photo ID, Social Security number and date of birth
- Hospital privilege letters, if any
- Supervision or collaboration agreement, where the payer requires one
For the group or facility
- Group NPI (Type 2) and Tax ID with the IRS CP 575 or 147C letter
- Signed W-9
- Bank letter or voided check for EFT enrollment
- Service location addresses, phone numbers and hours
- CLIA certificate, if you run in-office labs
- Facility license from ADHS, if applicable
Recredentialing, Revalidation and Monitoring So No One Falls Out of Network
Getting credentialed is half the job. Staying credentialed is where most practices lose money, because the deadlines are spread across a dozen portals.
| What we track | How often |
|---|---|
| CAQH ProView re-attestation | Every 120 days |
| Commercial payer recredentialing | Usually every 36 months, following NCQA standards |
| Medicare revalidation | Every 5 years (every 3 years for DMEPOS suppliers) |
| AHCCCS revalidation | On the schedule AHCCCS sets for your provider type |
| State license, DEA and CSPMP | Before each renewal date |
| Malpractice insurance | Before each policy renewal |
| Board certification | Before each expiration or MOC deadline |
We check providers against the OIG List of Excluded Individuals and Entities (LEIE), SAM.gov and the AHCCCS excluded provider list, and flag any license or board action. Primary source verification follows NCQA, URAC and Joint Commission expectations, so your files hold up when a payer or hospital audits them.
Why Practices Outsource Credentialing
| Comparison | Doing it in-house | Arizona Billing Services |
|---|---|---|
| Who does the work | An office manager, between everything else | A credentialing specialist assigned to each provider |
| Payer follow-up | When someone remembers | Every week, logged |
| Deadlines | Spread across calendars and inboxes | One tracked calendar for every renewal |
| Arizona payer know-how | Learned one rejection at a time | Already built in, from AHCCCS plans to closed panels |
| After approval | Effective dates often never reach billing | IDs and dates loaded into billing before the first claim |
Ways to Work With Us
Credentialing only
We handle enrollment and maintenance; you keep billing in-house.
Credentialing with billing
Enrollment plus claims, coding, denial management and A/R follow-up under one team.
One-time project
A new practice opening, a new location, or a batch of new hires.
Ongoing maintenance
CAQH, recredentialing, revalidation and roster updates on a monthly basis.
Medical Credentialing Services: Your Questions Answered
Find Out When Your Provider Can Start Billing
Tell us who you're adding and which payers you want. Within 5 business days you get a written credentialing plan: what's already in place, what's missing, the order we'll file in and a realistic start-billing date for each payer. No cost, no contract.
Rather talk it through? Call (631) 652-3106, Monday to Friday, 8 a.m. to 5 p.m. MST.