Payer Enrollment, Actively Managed.
We manage your entire payer enrollment pipeline — CAQH profile management, application submission, active follow-up, and final activation confirmation. We handle enrollment, not primary source verification (PSV); credentialing decisions stay entirely with your payers.
What Payer Enrollment Includes
CAQH Profile Setup & Maintenance
Professional profile creation and maintenance.
Application Preparation
Meeting specific requirements for every payer.
Payer Submission
Accurate filing to administrative centers.
Active Tracking & Follow-Up
Continuous monitoring of application status.
Deficiency & Denial Resolution
Immediate action on any administrative hurdles.
Written Activation Confirmation
Ensuring billable status is formally recorded.
Revalidation Monitoring
Tracking CAQH re-attestation every 120 days.
Our Process
01
Document & Credential Collection
Gathering licenses, malpractice insurance, NPI, and provider details.
02
CAQH Profile Management
Building and maintaining an accurate, attested profile.
03
Payer Submission
Preparing and submitting applications tailored to each payer's specific requirements.
04
Active Tracking & Follow-Up
Following up on a set cadence, not waiting for payers to respond.
Why Delays Happen
- Incomplete applications
- Expired licenses or malpractice insurance mid-review
- Un-attested or outdated CAQH profiles
- Data mismatches between NPI, CAQH, and applications (name, license number, tax ID typos)
- Payer volume spikes during high-demand periods like Q1
Turnaround Expectations
Commercial
120 days (industry-typical)
Medicare
60-90 days Standard CMS/PECOS timelines
Medicaid
60–180 days (industry-typical)
Note: These are industry benchmarks Medroll actively works to beat through clean submissions & proactive follow-up.
Specialties We Serve
Behavioral Health
- ABA
- Autism Spectrum Disorder Services
- Psychiatry
- Psychology
- Marriage & Family Therapy
- Substance Use Disorder/Addiction Treatment
- Speech-Language Pathology
- Occupational Therapy
- Mental Health Counseling
- Intensive Outpatient Programs (IOP)
Medical
- Primary Care
- Internal Medicine
- Pediatrics
- Cardiology
- Orthopedics
- Dermatology
- OB/GYN
- Neurology
- Gastroenterology
- Physical Therapy
- Urgent Care
- Radiology
- General Surgery
Payers We Work With (including but not limited to)
Commercial
UnitedHealthcare, Aetna (CVS Health), Cigna, Elevance Health/Anthem BCBS, Humana, Kaiser Permanente, HCSC, Highmark
Medicare Advantage
Original Medicare (CMS/PECOS), UHC MA, Humana MA, Aetna Medicare, Kaiser Medicare, BCBS Medicare Advantage
Medicaid & MCOs
Centene (Ambetter, Health Net, Fidelis Care), Molina Healthcare, UHC Community Plan, Elevance/Anthem Medicaid, CVS/Aetna Better Health, AmeriHealth Caritas, CareSource, WellCare
Behavioral Health
Optum Behavioral Health, Magellan Healthcare, Beacon Health Options, Cigna Behavioral Health