Question 1

What is the expected timeframe for completing the credentialing process?

Accepted Answer

Turnaround times differ by insurance carrier. Most major carriers complete the process within 90–120 days, while smaller plans can take even longer.
After a provider submits a participation request, two steps occur:

Credentialing:
 The carrier verifies all documents, checks qualifications, and sends the file to its credentialing committee for approval.
Contracting:
 Once approved, the provider moves into contracting, where participation is finalized and an effective date is issued.
Commercial insurers do not permit retroactive billing. Providers can only bill and get paid for services rendered after they are officially listed as in-network in the carrier’s system. Anything performed before that point is considered out-of-network and may leave patients responsible for significantly higher costs.

Question 2

How long does it take to get enrolled in Medicare?

Accepted Answer

Enrollment in Medicare usually takes 60–90 days, but the exact timeline depends on the state. The effective date is the day Medicare receives the application, which allows providers to bill retroactively for any services delivered between submission and approval. Medicare also grants a 30-day look-back window, meaning providers can bill for services rendered up to 30 days before the effective date.
For DMEPOS suppliers (durable medical equipment, prosthetics, orthotics, and supplies), processing takes longer. Applications face stricter review, and suppliers must complete a mandatory site visit. During this visit, inspectors verify the physical location, posted operating hours, inventory storage, and other compliance requirements needed to qualify as a DMEPOS supplier.

Question 3

Can CNS make the credentialing process move faster?

Accepted Answer

CNS cannot shorten Medicare’s processing timeline, but we streamline and manage the entire credentialing process from start to finish—from preparing initial applications to handling all carrier follow-ups. Our specialists understand every step, preventing delays and eliminating the errors providers often run into when navigating the process on their own.

Question 4

Do I need a service location to start credentialing?

Accepted Answer

Yes. Providers must have an established place of service before beginning credentialing and contracting. A home address cannot serve as a clinical practice address—whether temporarily or permanently. It may be used only for billing or mailing, and only if a separate physical practice location is listed.
If your office space is still being built, you can still use that address. Applications may be submitted up to 30 days before the official opening, and most commercial payers follow the same rule.

Question 5

How do I complete Medicare revalidation?

Accepted Answer

Medicare requires providers to revalidate every five years, while DMEPOS suppliers must revalidate every three years. Individual practitioners can complete revalidation by submitting a CMS-855I paper application or by using PECOS to file electronically.
You must respond to your Medicare contractor within 60 days of receiving the revalidation notice. Failure to do so can result in loss of billing privileges.
For groups or suppliers, revalidation is done using the CMS-855B. If the group does not already have an electronic funds transfer (EFT) on file, one must be set up as part of the revalidation process.

Question 6

Which Medicare application is used for provider enrollment?

Accepted Answer

The CMS-855I is the primary application for individual provider enrollment in Medicare. Both physicians and non-physician practitioners use this form. Additional documentation depends on provider type.
You may also need supporting forms:
• CMS-460 – Used to choose participating status with Medicare. Without it, a provider may default to non-participating status, which pays lower reimbursement but allows limited balance billing (up to 115% of the Medicare fee schedule).
• CMS-855R – Required when a provider joins an existing group. It reassigns Medicare payments to the group practice.
 – If the provider is already enrolled in that jurisdiction: submit only CMS-855R.
 – If not yet enrolled: submit CMS-855I + CMS-855R.
• CMS-588 – Required for both individuals and groups to set up electronic funds transfer (EFT). Medicare does not issue paper checks.
Summary of forms:
• Solo provider forming a new practice: CMS-855I, CMS-460, CMS-588
 • Provider joining a group (already enrolled): CMS-855R
 • Provider joining a group (not enrolled): CMS-855I + CMS-855R
 • CMS-460 may be required depending on the group’s participation status

Question 7

What is a CP575?

Accepted Answer

A CP575 is the official IRS letter issued when a business is first assigned an Employer Identification Number (EIN). Medicare requires this document as proof of the business’s legal name when submitting an enrollment application.
If the original CP575 is lost, the IRS can issue a 147C letter, which serves as an acceptable replacement. Medicare accepts only the CP575 or the 147C as valid EIN verification.

Question 8

What does CNS handle during the credentialing process?

Accepted Answer

CNS manages the entire enrollment process from start to finish. This includes gathering documents, completing all payer applications, verifying information, submitting forms, tracking progress, and following up with insurance panels until approval. You get full visibility while we handle the heavy lifting.

Question 9

How long does credentialing usually take?

Accepted Answer

Credentialing timelines vary by payer. On average, commercial insurance panels take 45–90 days, while Medicare and Medicaid may take longer. CNS expedites every step within our control and provides ongoing status updates so you always know where things stand.

Question 10

Do I need a CAQH profile before credentialing begins?

Accepted Answer

Yes. Most payers require an active, up-to-date CAQH profile. If you don’t have one, CNS will help you set it up. If you already have a profile, we update, verify, and maintain it so your applications aren’t delayed.

Question 11

What documents are required for provider enrollment?

Accepted Answer

Common requirements include:
 • NPI (Type 1 or Type 2)
 • State license(s)
 • Malpractice insurance
 • W-9
 • CAQH login
 • IRS letter (CP575 or 147C) for group practices
 CNS reviews everything to ensure every application is complete and compliant before submission.

Question 12

What is included in your practice consulting service?

Accepted Answer

Our consulting focuses on strengthening the operational side of your practice. We assist with workflow optimization, compliance guidance, payer mix recommendations, documentation support, CAQH maintenance, and readiness for audits or renewals. The goal is to help your practice operate efficiently and increase revenue.

Question 13

Do you offer billing services along with credentialing?

Accepted Answer

Yes. CNS provides full medical billing support for mental-health providers. This includes claim submission, payment posting, denial management, eligibility checks, and monthly financial reporting. You can use credentialing alone or combine both services for a smoother revenue cycle.

Frequently asked questions