Provider Credentialing Services for Independent Practices
We enroll your providers with the payers you need, keep CAQH current, and show every application's status in one pipeline.
- $150 per payer application
- Live credentialing pipeline in Apex
- Medicare, Medicaid, Medicare Advantage and commercial payers
Use the form to get a credentialing plan for your providers.
Scope
What we handle
New provider enrollment, per payer
We prepare and file each payer application: Medicare through PECOS (855I, 855B, 855R, and 855A for institutional providers), state Medicaid and Medicaid managed care plans, commercial plans and TRICARE. One application per payer per provider, and sub-plans that need their own application are counted separately.
CAQH profile setup and upkeep
We build the CAQH profile, keep documents and practice details current, and track the 120-day attestation date for each provider. The provider completes the attestation, and we tell them when it is due.
Group and location linkage
Approval alone does not let a provider bill under your group. We file the Medicare 855R reassignment to the group and the commercial group contract amendment, so each provider is tied to the right tax ID and locations.
Recredentialing
Commercial plans recredential on a cycle. We track each provider's dates per payer and complete the recredentialing file before it is due.
Medicare and Medicaid revalidation
Medicare revalidates every 5 years (42 CFR 424.515). Medicaid revalidates at least every 5 years, and states may require it more often (42 CFR 455.414). We track each provider's due dates and file before the deadline. A missed revalidation deactivates billing privileges, and services furnished while deactivated are not paid (42 CFR 424.540(e); 424.555(b)).
Changes
New practice location, new tax ID, ownership change, and a provider leaving the group, which ends their reassignment. We file each change with every affected payer. A new tax ID means a new enrollment, not an amendment. Medicare requires a change of ownership or a practice location change to be reported within 30 days, and most other changes within 90 days (42 CFR 424.516(d)). Other payers report within their own windows. For the detail, read adding a location, a tax ID or a group.
Medicare Advantage
Medicare Advantage plans run their own credentialing, separate from Original Medicare enrollment, so each plan the practice needs is its own application. We credential with the Medicare Advantage plans the practice chooses.
Follow-up continues until each payer has loaded the provider's effective date, not just until the application is sent. If a provider is already waiting on a stuck application, start here.
The rules
The clocks that keep a provider billable
Six dates decide whether a provider's claims get paid. Each one runs separately for every provider and every payer. CAQH is now DataSpring, powered by CAQH, after a rebrand on 7 June 2026.
| Clock | Rule | Source |
|---|---|---|
| Medicare effective date | The later of the filing date of an application that is approved, or the first date of service at the new location. | 42 CFR 424.520(d) |
| Medicare reach-back | Up to 30 days before the effective date if circumstances precluded enrolling earlier, or 90 days after a presidentially declared disaster. | 42 CFR 424.521(a) |
| Medicare revalidation | Every 5 years. Services furnished while billing privileges are deactivated are not paid. | 42 CFR 424.515, 424.555(b) |
| Medicaid revalidation | At least every 5 years. States may set their own schedules. | 42 CFR 455.414 |
| CAQH attestation | Every 120 days. | DataSpring, powered by CAQH |
| Recredentialing | At least every 36 months under NCQA standards, which many commercial plans follow. | NCQA |
Last checked: 5 Oct 2026
File Medicare before the provider's first patient, because the reach-back is only 30 days. Track every clock per provider per payer, because one lapse stops payment. For sequencing, retroactive billing and state rules, read the full credentialing guide.
Process
How an enrollment runs
- 01
Document collection
Licenses, DEA, board certification, malpractice certificate, work history and CV, gathered once and reused for every payer.
- 02
CAQH profile complete
The profile is built and checked, and the provider attests.
- 03
Applications filed per payer
Each application goes out complete, with the submission documented.
- 04
Follow-up to the effective date
We follow up on a schedule until each payer has loaded the provider's effective date.
- 05
Group and location linkage confirmed
Reassignment and contract amendments are confirmed per payer and location.
- 06
Effective dates loaded
Each date goes on file so claims are not released before a payer's start date.
- 07
Status visible in Apex
Every application's status shows in Apex's credentialing pipeline.
We do not quote a turnaround, because each payer sets its own timeline. What you control is the start date: the earlier the applications go out, the fewer days a new provider cannot bill. Use the planner to plan a provider's enrollment timeline.
Before and after
How the process changes
How the process changes. Not a record of any one client.
Effective dates
BeforeClaims go out before a payer's start date.
AfterEach provider's date per payer is on file before claims release.
CAQH
BeforeAttestation lapses unnoticed.
AfterAttestation dates tracked per provider.
Group linkage
BeforeProvider approved but not linked to the group.
AfterLinkage confirmed per payer and location.
Recredentialing
BeforeA plan's recredentialing request sits unanswered.
AfterRecredentialing dates tracked per payer.
Revalidation
BeforeA revalidation notice arrives, nobody acts, and billing privileges deactivate.
AfterDue dates tracked per provider; filed before the deadline.
Changes
BeforeA new address or tax ID never reaches the payers, and claims deny while everything else is correct.
AfterEvery affected payer updated or re-enrolled.
Medicare Advantage
BeforeMedicare Advantage plans assumed to be covered by the Medicare enrollment.
AfterEach Medicare Advantage plan the practice needs is credentialed on its own.
Visibility
BeforeStatus lives in someone's inbox.
AfterOne pipeline view in Apex.
What clients say about working with Quilven
I appreciate the professionalism, the courtesy, the knowledge.
What you have provided for me was a detailed of things that are going wrong that needed to change in our practice.
I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.
Pricing
What credentialing costs
Credentialing
$150
per payer application, for credentialing-only clients
- ✓One application per payer per provider. Sub-plans that need their own application count separately.
- ✓Billed only after the payer confirms the application is accepted or in process.
- ✓No charge if the payer's panel is closed.
- ✓Application count and total confirmed in writing before work starts.
- ✓CAQH upkeep, group linkage and follow-up to the loaded effective date.
Billing clients: credentialing, revalidation, change filings and Medicare Advantage credentialing are included in the billing percentage. Not included: fees a payer charges for the application itself, which are passed through at cost with no markup.
Other services
Medical billing
3 to 5%
of collections by monthly volume, $500 monthly minimum
See the full pricing detail.
Visibility
What you see in Apex
Apex shows the credentialing pipeline as it moves: every provider, every payer, and every application's status, from documents requested to effective date loaded. You can see which payers are done, which are waiting on the payer, and which need something from the provider, without asking for an update. CAQH attestation dates and recredentialing dates sit in the same view.
Quilven is a managed service, not software you have to run. Apex is how you see the work.
Company
Who Quilven is
Quilven is a managed revenue cycle service. Not software, not an EHR, and not a proprietary platform you have to adopt. We work inside the system your practice already uses, across 30+ integrations, with no data migration and no workflow change. Our clients are independent practices with 3 to 25+ providers.
Pricing is straightforward. AR recovery is 12 to 15 percent of the recovered amount. Medical billing is 3 to 5 percent of collections by monthly volume, with a $500 monthly minimum. Credentialing is $150 per payer application for credentialing-only clients, and included in the billing percentage for billing clients.
The entry point is a free RCM audit. It takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, so the first thing you get from us is a diagnosis you can act on with or without us.
We lead with method and evidence rather than tenure. Quilven was founded in 2025 by Raief Shick and works from 159 4th Ave N, Suite 100, Nashville, TN 37219. The entity is registered in Wyoming. Reach us at (202) 490-9406 or info@quilven.com.
Fit
Who this is for
- →Independent practices adding providers
- →New practices enrolling for the first time
- →Groups changing tax ID, ownership or location
- →Practices with lapsed CAQH profiles or overdue recredentialing
It is not for hospitals that need medical staff privileging or primary source verification. We do not offer either. If a new provider is already waiting, estimate the revenue at risk while you wait.
FAQ
Common questions
Next step
Get a per-payer plan and price
Tell us how many providers you are adding and which payers they need. We reply with a plan listing every application, at $150 per payer application, with the count and total confirmed in writing before any work starts. Payer application fees pass through at cost.
Prefer to talk it through? Book a call.
(202) 490-9406 · info@quilven.com