Payer enrollment

Enrollment

• Commercial payer enrollment, $200 to $375 per payer
• Medicare enrollment for mid-level clinicians, $300 to $375
• Medicaid enrollment by state, quoted per state
• CAQH profile build or remediation, $100 to $300

Every nurse practitioner and physician assistant needs individual enrollment with Medicare and every commercial plan in every state where they see patients. Incident-to billing does not apply to telehealth, so a virtual-first group cannot shelter mid-level clinicians under a supervising physician's NPI.

Keeping enrollment alive

• 90-day directory attestation across every payer portal
• Re-credentialing cycles, $75 to $150 per cycle outside the subscription
• Medicare revalidations, $150 to $250 outside the subscription
• Monthly exclusion screening against OIG and state lists

These are inside the Standard and Full lifecycle subscription tiers. The attestation cycle is the single most common cause of a clinician quietly dropping out of a payer directory.

Who signs

We prepare the filing and hold the account through CMS Third-Party Organization surrogacy and the CAQH Practice Manager Module. Form CMS-855I states the practitioner is the only person who may sign, so certification always routes back to the clinician. More on the authority model.