Payer enrollment

Enrollment

• Commercial payer enrollment, $350 per payer
• Medicare enrollment for nurse practitioners and physician assistants, $350, then again on the five-year cycle
• Medicaid enrollment by state, quoted per state
• CAQH management, $200 per 120-day cycle
• Roster and demographic updates, $50 to $150 per change

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
• Commercial re-credentialing, $250 per 36-month cycle outside the subscription
• Medicare or Medicaid revalidation, $450 per five years outside the subscription
• Monthly exclusion screening against OIG and state lists

These are inside the Standard and Complete 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.