| Payer enrollment | $200 per enrollment |
|---|---|
| CAQH & Availity management | $100 per provider / year |
| New state license | $600 per state |
| State controlled-substance registration | $200 per state |
| DEA registration (new) | $150 per state |
| State or DEA renewal | $150 per renewal |
| Filing fees | Government and board fees passed through at cost |
| Contract minimum | None; priced per request |
How credentialing companies price their work
- 01Per application: a fee for each provider-payer enrollment. Easiest to compare, because you can count what you need.
- 02Per provider per month: a monthly fee that bundles enrollments, CAQH upkeep and re-credentialing for each provider.
- 03Bundled with billing: some medical billing companies include or discount credentialing when they also handle your claims, usually for a percentage of collections.
- 04Project or hourly: for one-off work such as cleaning up a large roster or catching up on lapsed enrollments.
What drives the total
- 01Providers × payers. Every provider usually needs a separate enrollment with every plan, so this multiplication is most of the bill.
- 02Starting point. A current CAQH profile, NPPES record and license file is quicker to work from than a provider starting from scratch.
- 03Medicare and Medicaid. Group enrollment, individual enrollment and reassignment are separate filings.
- 04Licenses first. A provider without a license, controlled-substance registration or DEA in the state needs those before payers will enroll them.
- 05Upkeep. CAQH re-attestation every 120 days, Medicare revalidation every five years and payer re-credentialing (commonly every three years) all recur.
Worked example with Rivon's prices
A new group with 3 providers wants 8 payers (for example Medicare, Medicaid and six commercial plans). That's 3 × 8 = 24 enrollments at $200 per enrollment = $4,800. Keeping all 3 CAQH and Availity profiles current for a year adds $300. Total: $5,100, plus any filing fees, paid per request rather than as a monthly retainer.
If one of the providers still needs a license in the state, add $600 per state for the license, $200 per state for a state controlled-substance registration where the state requires one, and $150 per state for the DEA registration.
Questions to ask any credentialing company
- 01Exactly what's included: follow-ups, CAQH upkeep, revalidations, re-credentialing, Medicaid managed-care plans.
- 02Whose name the logins are in. CAQH, PECOS, NPPES and payer portals should belong to your practice.
- 03How you see status: each application with its submission date, reference number and next follow-up.
- 04What happens if a payer's panel is closed or an application is denied.
- 05Whether filing fees are passed through at cost or marked up, and whether they'll sign a BAA.
Doing it yourself with software instead
Many groups keep routine enrollments in-house and outsource only overflow or new states. Rivon's platform tracks every application, document and expiration (Free up to 6 providers; paid plans up to $1,499/mo), and any single request can be handed to Rivon's specialists at the prices above.
Frequently asked questions
Who are the top outsourced credentialing companies?
They fall into three groups: credentials verification organizations (CVOs) such as Verisys, managed credentialing platforms such as Medallion and Assured, and medical billing companies that add credentialing. Rivon Health is a credentialing software company with a done-for-you service and public prices ($200 per enrollment per payer enrollment, $100 per provider / year for CAQH and Availity management), so you can compare its cost before talking to anyone.
How much does outsourced medical credentialing cost?
It depends on the pricing model: per application, per provider per month, or bundled into billing. Rivon Health's prices are public: $200 per enrollment for a payer enrollment and $100 per provider / year for CAQH and Availity management, with filing fees at cost and no contract minimum.
Are government and board filing fees included?
No. Filing fees set by licensing boards, the DEA and some state Medicaid programs are passed through at cost and shown separately, so you can see exactly what goes to the government.
Should we credential in-house or outsource it?
Outsourcing makes sense for a burst of work (a new practice, a new state, a backlog) or when no one on staff has time for follow-up calls. In-house works when someone owns it and has a good tracker. Many teams do both: Rivon's platform for routine work (Free up to 6 providers; paid plans up to $1,499/mo) and per-request specialist help for the rest.
Does outsourcing make payers approve faster?
Payers set their own review times. A good credentialing company prevents the delays you control: missing documents, expired CAQH attestations, mismatched NPI details and missed follow-ups.
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