Prime RCM:
Best Medical & Insurance Credentialing Service in the USA
Tired of delayed provider enrollment, claim denials, or compliance hurdles? Prime RCM empowers healthcare providers to streamline physician credentialing, Medicare/Medicaid enrollment, and hospital privileges with unmatched precision. From urgent care credentialing to expedited insurance credentialing services, we ensure 99% first-time approval rates and fast-tracking your in-network integration with top payers.
Our credentialing services cover every US healthcare provider credentialing needs. Whether you’re a physician, urgent care, or multi-specialty practice, we handle all provider enrollment and credentialing services. Prime RCM ensures error-free approvals, faster reimbursements, and 100% compliance. Trusted by clinics and healthcare providers across the USA.
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What is Medical and Insurance Credentialing?
Credentialing is the systematic process of verifying a provider’s qualifications, licenses, and professional history to ensure compliance with industry standards. Medical credentialing focuses on validating education, training, certifications, malpractice history, and hospital privileges through primary source verification. Insurance credentialing enrolls providers into payer networks like Medicare, Medicaid, or private insurers to legally bill for services. This dual process includes CAQH ProView registration, NPI issuance, and payer enrollment to meet strict insurer requirements. To maintain compliance, providers must complete re-credentialing every 2-3 years. Proper credentialing reduces claim denials, speeds reimbursements, and prevents penalties—ensuring trust, revenue stability, and smooth practice operations.
Prime RCM
Exclusive Credentialing Services
Prime RCM provides complete medical coding services designed to optimize accuracy, compliance, and financial outcomes for healthcare providers in the USA. Our AHIMA-certified coders ensure precise translation of clinical documentation into codes compliant with CMS, Medicare, and U.S. payer guidelines.
Medicare & Medicaid Enrollment
Medicare & Medicaid Enrollment
Prime RCM accelerates your enrollment in Medicare and Medicaid programs. We ensure strict compliance with CMS guidelines. We manage every detail—from PECOS enrollment and MACs coordination to document verification (licenses, IRS forms, practice agreements)—to fast-track approvals for Medicare Part B, Medicaid Managed Care, and Medicare Advantage plans. Our team resolves discrepancies and handles revalidation every 3-5 years. By securing your participation, we expand access to millions of patients and stabilize revenue streams.
Commercial Insurance Credentialing
Commercial Insurance Credentialing
Securing in-network status with private insurers is critical for maximizing revenue and patient reach. Our commercial insurance credentialing experts manage every step to enroll you with top payers like Aetna, Cigna, United Healthcare, and Blue Cross Blue Shield. Our team prepares and submits error-free applications, negotiates competitive reimbursement rates, and resolves bottlenecks like missing documentation or payer backlogs.
We go beyond the basics. We audit existing contracts to address underpayments, renegotiate terms for higher reimbursements, and ensure compliance with evolving insurer policies. With proactive follow-ups and deep payer relationships, we slash approval timelines by 30-50%, accelerating your access to millions of insured patients.
CAQH ProView Management
CAQH ProView Management
We are specialized in optimizing CAQH ProView profiles. Our team handles the end-to-end management of your profile, starting with accurate initial setup using verified credentials (licenses, certifications, work history) and ensuring compliance with CMS and NCQA standards. We regularly update your profile with new certifications, expiring documents, and re-attestation cycles, eliminating manual errors that delay approvals. By centralizing data for multi-payer credentialing, we reduce redundant paperwork and accelerate enrollment with private insurers.
Primary Source Verification
Primary Source Verification
We also primary source verification (PSV) to validate every critical detail of a provider’s professional background. This includes directly contacting issuing authorities—such as state medical boards, FSMB (Federation of State Medical Boards), NBME (National Board of Medical Examiners), and AMA (American Medical Association)—to confirm the authenticity of licenses, board certifications, medical school diplomas, and residency training records. We also verify work history with previous employers and scrutinize malpractice claims via the NPDB (National Practitioner Data Bank).
Our team cross-checks sanctions through OIG (Office of Inspector General) and SAM.gov databases to ensure no exclusions exist. By adhering to Joint Commission and NCQA standards, we eliminate discrepancies that could trigger audits or fines. With Prime RCM, your practice avoids costly delays, maintains compliance, and builds trust with patients, payers, and healthcare facilities.
Our team cross-checks sanctions through OIG (Office of Inspector General) and SAM.gov databases to ensure no exclusions exist. By adhering to Joint Commission and NCQA standards, we eliminate discrepancies that could trigger audits or fines. With Prime RCM, your practice avoids costly delays, maintains compliance, and builds trust with patients, payers, and healthcare facilities.
Hospital Privileges Facilitation
Hospital Privileges Facilitation
Securing hospital privileges is critical for admitting and treating patients in acute care, surgical centers, or specialty facilities. Prime RCM streamlines this intricate process by preparing detailed applications tailored to each facility’s bylaws, including proof of credentials, peer references, and procedural competency documentation. We coordinate with medical staff offices, address queries, and ensure compliance with facility-specific requirements (e.g., vaccination records, ACLS certifications). For providers seeking privileges at multi-site health systems, we manage cross-facility coordination to avoid redundant paperwork. By anticipating bottlenecks—like missing signatures or outdated documents—we accelerate approvals, so you gain faster access to operating rooms, diagnostic tools, and specialist collaborations.
NPI Registration (Type 1 & Type 2)
NPI Registration (Type 1 & Type 2)
Prime RCM, also offers NPI registration for healthcare providers and organizations, ensuring compliance with HIPAA and CMS mandates. A National Provider Identifier (NPI) is a unique 10-digit number required for all billing transactions, insurance claims, and electronic health records (EHR) systems. For individual providers (Type 1 NPI), we verify personal credentials, submit applications, and resolve CMS discrepancies—like mismatched license data or incomplete documentation—to prevent delays. For organizations (Type 2 NPI), we register group practices, clinics, or healthcare facilities, aligning details with IRS records and payer databases. Errors in NPI registration can trigger claim denials, payment delays, or audits. Our team ensures error-free setup, updates registries proactively, and integrates NPIs seamlessly with payer enrollments and CAQH ProView profiles.
Re-credentialing & Renewals
Re-credentialing & Renewals
Medical credentialing isn’t a one-time task—it requires ongoing updates to maintain compliance and payer network eligibility. At Prime RCM, we automate the entire re-credentialing process, ensuring timely renewals for state medical licenses, DEA certifications, malpractice insurance, and payer enrollments (Medicare, Medicaid, and private insurers like Blue Cross). Our team tracks critical deadlines, submits error-free applications, and resolves discrepancies with state boards or insurers before expiration dates hit. We handle tedious tasks like CAQH ProView re attestations, payer revalidation, and OIG sanction checks, preventing lapses that could trigger claim denials, audits, or network removal.
Sanction & Exclusion Monitoring
Sanction & Exclusion Monitoring
Prime RCM safeguard your practice from compliance risks with rigorous sanction and exclusion monitoring. Federal and state regulations require providers to screen against the U.S. Department of Health and Human Services’ OIG List, SAM.gov, and state-specific exclusion databases. Even unintentional ties to sanctioned entities can trigger audits, fines, or revoked billing privileges. Our team conducts continuous monitoring—reviewing updates monthly, cross-referencing employee and vendor records, and flagging potential red flags. If discrepancies arise, we investigate sources (e.g., past employers, licensure boards), resolve errors, and document corrective actions to satisfy CMS and payer requirements.
Claim Denial Prevention Audits
Claim Denial Prevention Audits
We proactively identify and resolve credentialing errors that lead to costly claim denials. Our audits cross-check payer enrollments, CAQH profiles, and NPI data to ensure alignment across all platforms. For example, mismatched provider names, expired licenses, or outdated taxonomy codes can trigger rejections—we catch these gaps early. We also verify that your practice’s details (e.g., addresses, TINs, and specialty designations) match insurer records, eliminating discrepancies. By reconciling data in real-time and resolving issues pre-submission, we reduce denial rates by up to 99%.
Custom Credentialing Solutions
Custom Credentialing Solutions
Every practice has unique needs. Whether you are expanding into telehealth, offering durable medical equipment (DMEPOS), or managing a multi-state urgent care clinic. At Prime RCM, we specialize in custom credentialing solutions according to your niche. Need telehealth licensing across 10 states? We handle multi-state applications, compact licenses, and payer-specific virtual care requirements. For DMEPOS enrollment, we ensure Medicare compliance, facility accreditation, and product-specific documentation. Urgent care clinics benefit from our expedited credentialing with payers like UnitedHealthcare or Cigna, minimizing delays in high-demand settings.
Prime RCM:
We also support
We understand that every healthcare service provider is not alike. Whether you are scaling operations, entering new markets, or tackling complex regulations. Prime RCM has the complete solution for all of your credentialing needs.
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Importance of Medical and Insurance Credentialing
Medical and insurance credentialing is how healthcare providers prove they’re qualified and trustworthy. It checks your licenses, training, and work history to meet government rules (like Medicare or Medicaid) and insurance company standards (Aetna, UnitedHealthcare). Without it, you can’t bill insurers, get paid on time, or keep your practice running.
Credentialing stops claim denials by ensuring your NPI number, hospital privileges, and DEA license are up-to-date. It also keeps you off government watchlists (OIG, SAM.gov) and avoids fines. Regular updates (every 2-3 years) keep you in-network with insurers, so patients can find you and pay less.
Credentialing stops claim denials by ensuring your NPI number, hospital privileges, and DEA license are up-to-date. It also keeps you off government watchlists (OIG, SAM.gov) and avoids fines. Regular updates (every 2-3 years) keep you in-network with insurers, so patients can find you and pay less.
Prime RCM Recredentialing:
Outsourcing Medical Credentialing and Recredentialing
Outsourcing medical Credentialing and Recredentialing allows healthcare providers to transfer the intricate, time-sensitive task of verifying qualifications, licenses, and payer enrollments to specialized experts. This includes primary source verification (medical licenses, education, malpractice history), CAQH ProView management, NPI registration, and renewals for Medicare, Medicaid, and private insurers (e.g., Aetna, UnitedHealthcare). Recredentialing—mandated every 2-3 years—is streamlined to ensure continuous compliance and prevent disruptions in network participation.
Prime RCM
Benefits of Outsourcing Medical Credentialing Services
Why Choose Prime RCM For a Medical Credentialing Outsourcing Partner?
Navigating medical credentialing alone is risky. One error can delay reimbursements, trigger audits, or cost you patients. At Prime RCM, we combine precision, speed, and compliance to protect your reputation and revenue. Here is why healthcare providers nationwide trust us:
Expertise and Proven Results
With 15+ years of specialized experience in medical credentialing services, Prime RCM’s team understands the intricacies of CMS guidelines, state-specific licensing requirements, and private payer policies (Aetna, Cigna, UnitedHealthcare). We’ve successfully credentialed over 10,000 providers across specialties—from primary care to telehealth—ensuring a 99% first-time approval rate. Whether you’re enrolling in Medicare, securing hospital privileges, or negotiating contracts, our expertise minimizes delays and maximizes revenue from day one.
End-to-End Compliance Safeguards
Compliance isn’t a checkbox—it’s a commitment. We conduct monthly OIG sanction checks (SAM.gov, state exclusion lists), automate DEA renewals, and align with Joint Commission and NCQA standards to keep your practice audit-ready. Our proprietary tracking system flags expiring licenses, incomplete CAQH ProView attestations, or payer revalidations months in advance, ensuring zero lapses. With Prime RCM, you avoid fines, network removals, and reputational damage.
Faster Turnarounds, Fewer Delays
Slow credentialing costs you patients and profits. Prime RCM accelerates approvals by 40% through proactive insurer follow-ups, error-free NPI registrations, and optimized Medicare/Medicaid enrollment workflows. We pre-verify documents, resolve discrepancies with state boards, and leverage direct payer contacts to fast-track applications. For urgent needs, our expedited credentialing service prioritizes applications, getting you in-network with top insurers in weeks, not months.
Transparent, Scalable Solutions
From solo practitioners to multi-specialty groups, our services grow with you. We offer flat-rate pricing for telehealth licensing (multi-state), urgent care credentialing, and DMEPOS enrollment, with no hidden fees. Our team adapts to your workflow—whether you’re expanding to new states, adding providers, or integrating behavioral health services. With Prime RCM, scalability means seamless growth, not administrative chaos.
Revenue Cycle Protection
Incomplete credentialing causes 30% of preventable claim denials. We protect your revenue by auditing payer contracts, ensuring hospital privileges match facility requirements, and fixing enrollment gaps before claims are submitted. Our denial resolution team also recovers payments tied to credentialing errors, boosting collections by up to 25%. With Prime RCM, your revenue cycle stays healthy and predictable.
Dedicated Support
Forget automated systems or endless hold times. Every client gets a dedicated credentialing specialist—a single point of contact for re-credentialing, CAQH updates, or payer disputes. Need help with CLIA waivers or international graduate documentation? We’re here 24/7, offering step-by-step guidance. Our clients rate us 4.9/5 stars for responsiveness and expertise.
Medical Credentialing Process
Medical credentialing ensures providers meet regulatory, insurer, and facility standards to practice and bill legally. At Prime RCM, we streamline this complex workflow into a seamless, tech-driven process. Here’s how it works:
Prime RCM
Prime RCM Exclusives
15-Day Approval Guarantee:
Get payer-ready in half the standard time.
Denial-Proof Credentialing:
AI audits profiles pre-submission.
Hospital Privilege Negotiation:
Secure high-revenue procedural rights.
24/7 Provider Portal:
Track applications, contracts, and deadlines live.
optimized payer :
30% Higher Reimbursements with optimized payer contracts.
First-Time Approval:
99% First-Time Approval Rate in top networks.
Lapses:
Zero Lapses in credentials or privileges.
Compliance and Security Information
At Prime RCM, compliance and security is the foundation of our medical credentialing services. We safeguard your practice’s reputation, revenue, and sensitive data through rigorous protocols aligned with federal, state, and industry standards.
Regulatory Compliance
- HIPAA & HITECH Adherence: All data is encrypted (AES-256) during transit and storage.
- CMS Guidelines: Credentialing workflows meet Medicare PECOS and Medicaid requirements.
- OIG/SAM.gov Monitoring: Daily checks against exclusion lists to prevent audit risks.
- DEA & State Board Alignment: Automated renewal tracking for licenses and certifications.
Data Security
- SOC 2 Type II & ISO 27001 Certified: Your documents are protected in enterprise-grade, cloud-based systems.
- Role-Based Access: Multi-factor authentication (MFA) and granular permissions limit data exposure.
- Penetration Testing: Annual third-party audits to eliminate vulnerabilities.
Industry Standards
- Joint Commission & NCQA Compliance: Credentialing files meet accreditation benchmarks.
- CAQH ProView Security: End-to-end encryption for profile updates and attestations.
- NPI Registry Safeguards: Secure NPPES portal integrations prevent identity theft.
Proactive Risk Mitigation
- Real-Time Sanction Alerts: Immediate notifications for OIG, SAM.gov, or state exclusions.
- Audit Trail Logs: Track every document edit, submission, or access attempt.
- Breach Response: 24/7 monitoring and a dedicated incident response team.
Client Testimonial
Discover what Ritual users have to say:
Prime RCM took the headache out of credentialing. As a solo practitioner, I struggled with Medicare and Medicaid enrollment. Their team handled everything—CAQH ProView, NPI setup, even hospital privileges—in 30 days. No denials. No delays. Just peace of mind.
Prime RCM:
The Best Medical Credentialing Service in the USA
Prime RCM sets the gold standard for medical and insurance credentialing, empowering healthcare providers nationwide to secure Medicare, Medicaid, and private insurer enrollments with unmatched speed and precision. Our 99% first-time approval rate stems from rigorous primary source verification, AI-driven CAQH ProView audits, and seamless NPI registration, slashing claim denials by 40% and accelerating reimbursements. Whether navigating complex state licensing boards (Texas, California) or securing hospital privileges for ASCs and clinics, we ensure compliance with OIG, Joint Commission, and CMS mandates. Join thousands of providers who trust Prime RCM to protect revenue, eliminate paperwork, and focus on what matters—patient care. Experience why we’re ranked #1.
How long does Medicare enrollment take, and why does it vary?
Medicare enrollment typically takes 90-120 days, but delays occur due to incomplete documentation or CMS backlog. Prime RCM reduces this to 60-75 days via pre-audits, direct PECOS portal submissions, and proactive follow-ups.
Can credentialing errors cause claim denials months later?
Yes. Outdated CAQH profiles, expired licenses, or missing hospital privileges trigger retroactive denials. We conduct monthly audits to ensure ongoing compliance, preventing post-payment clawbacks.
Do you manage credentialing for group practices with multiple providers?
Yes. We scale seamlessly for groups, offering bulk enrollment discounts, centralized CAQH/NPI management, and automated renewal tracking for all providers under one dashboard.
How often do re-credentialing requirements change?
Re-credentialing cycles are set by payers (usually 2-3 years), but rules like OIG exclusion checks or state license renewals can update annually. We monitor changes in real time and adjust workflows proactively.
Can you handle multi-state credentialing for telehealth providers?
Yes. We specialize in securing licenses across all 50 states via the FSMB Interstate Compact and state-specific boards. Our team manages telehealth credentialing, including unique payer rules (e.g., Medicare telehealth billing), so you can practice virtually without compliance risks.
Do you support International Medical Graduates (IMGs)?
Absolutely. We verify ECFMG certifications, translate foreign transcripts, and assist with J-1/H-1B visa documentation required for state licensing. Our expertise ensures IMGs meet US credentialing standards seamlessly.
