Credentialing & Enrollment
Credentialing & Enrollment is a US-focused healthcare administrative services firm that handles medical credentialing, payer enrollment, re-credentialing, and related compliance services for solo and group practices, hospitals, HMOs, and government agencies across 30 states.
- Company typePrivate
- Founded2014
- HeadquartersRawalpindi, Pakistan
- Headcount51–100
- GTM typeB2B
- OfferingServices
What Credentialing & Enrollment does
Credentialing & Enrollment is a privately-held US-focused healthcare administrative services company that provides medical credentialing and payer enrollment services to healthcare providers. Its core offerings include initial medical credentialing, re-credentialing, provider enrollment with commercial insurers, Medicare and Medicaid, EDI enrollments, IPA enrollment, contract renegotiation, hospital privileges assistance, CAQH profile maintenance, and behavioral health credentialing. The firm serves a broad horizontal mix of customers spanning solo and private practice physicians, group practices, hospitals, HMOs, home health agencies, ambulatory surgical centers, diagnostic and imaging centers, insurance companies, and government agencies, with stated coverage across 30 US states and thousands of provider clients served since founding around 2014.
The company's technology stack is centered on a secure online client portal with real-time application tracking and a HIPAA-compliant physician database used for documentation, payer submission, and ongoing data maintenance. Service delivery relies on a team of approximately 30 specialty experts who manually execute payer-specific submissions, follow-ups, and compliance checks against NCQA and DHFS standards; the technology layer is positioned as an overlay on top of labor-intensive workflow rather than a platform that automates the credentialing process itself.
Commercially, the firm operates a sales-led professional services model with quote-based pricing, no publicly disclosed rate cards, and multi-year contract options. Go-to-market channels include the company website (with contact and quote forms), direct phone outreach to a US San Francisco contact number, email, and SEO-driven organic traffic; no enterprise sales motion, channel partnerships, or institutional contracts are documented. The company is bootstrapped and founder-owned, with no disclosed external funding, parent company, or acquisition history.
Credentialing & Enrollment firmographics
Firmographics- Name
- Credentialing & Enrollment
- Legal name
- Credentialing & Enrollment Services
- Website
- https://credentialingandenrollment.com
- Company type
- Private
- Founded year
- 2014
- Operating status
- Operating
- Headcount range
- 51–100 employees
- Short description
- Credentialing & Enrollment is a US-focused healthcare administrative services firm that handles medical credentialing, payer enrollment, re-credentialing, and related compliance services for solo and group practices, hospitals, HMOs, and government agencies across 30 states.
- Ownership category
- akta.pro rank
Credentialing & Enrollment industry classification
Industry- Product category
- Healthcare Credentialing & Provider Enrollment Services
- SIC
- Insurance Agents, Brokers & Service (6411)
- akta.pro primary industry
- Provider Credentialing & Enrollment (Payer Contracting Ops) (HLACACAM)
- akta.pro secondary industry
- Provider Network, Credentialing & Contracting Support (BPAAAFAI)
Keywords
Where Credentialing & Enrollment is headquartered
LocationHeadquarters
- HQ city
- Rawalpindi
- HQ country
- Pakistan
- HQ region
- Asia
Offices1 record
Markets served
Credentialing & Enrollment business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Provider Credentialing Services: Professional services for medical credentialing and enrollment of healthcare providers, including initial credentialing, re-credentialing, and ongoing maintenance of provider data with payers.
- Medical License Processing: Assistance with medical license applications and processing for healthcare providers.
- CAQH Credentialing: Services for CAQH (Council for Affordable Quality Healthcare) provider credentialing enrollment and maintenance.
- Medicare/Medicaid Enrollment: Provider enrollment services with Medicare and Medicaid programs.
- EDI Enrollments: Electronic Data Interchange enrollment services for healthcare providers.
- Hospital Privileges Assistance: Support services for obtaining hospital privileges for healthcare providers.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Other | Multi-year contract | Custom quote-based pricing |
Go-to-market motion1 record
Distribution channels3 records
Marketing channels5 records
Credentialing & Enrollment product offering
Product offeringCore offering
Credentialing & Enrollment provides outsourced medical credentialing and payer enrollment services for healthcare providers, including initial credentialing, re-credentialing, Medicare/Medicaid enrollment, CAQH profile management, EDI enrollments, IPA enrollment, hospital privileges assistance, contract renegotiation, and ongoing maintenance of provider data. A dedicated team handles documentation collection, payer submissions, follow-ups, and periodic updates on behalf of solo practices, group practices, hospitals, HMOs, home health agencies, ambulatory surgical centers, diagnostic and imaging centers, insurance companies, and government agencies.
Product overview
Credentialing & Enrollment is a healthcare administrative services company offering a comprehensive suite of provider credentialing and enrollment solutions. The core offering consists of Medical Credentialing, Re-Credentialing, and Provider Enrollment services, supported by a portfolio of add-on services including Contract Renegotiation, EDI Enrollments, IPA Enrollment, CAQH Credentialing, Medical License assistance, Medicare Enrollment, Hospital Privileges, and Behavioral Health credentialing. The company also provides Compliance, Data Integrity, Updates or Changes, and Maintenance of Data services. Their four-step process includes Documentation (collect and validate physician data), Payer Submission (file for credentialing with relevant payers), Ensure Enrollment (follow-up and track status), and Periodic Updates (maintain documentation). The services are offered to healthcare facilities, insurance companies, and government agencies, with a dedicated team handling submissions to commercial insurances, Medicare, and Medicaid.
Differentiator
Problem solved
Functional benefit
Products and services
- Medical Credentialing Processes medical credentialing applications for healthcare providers, verifying qualifications, education, training, licensure, work history, malpractice claims, and disciplinary actions for inclusion in payer networks.
- Re-Credentialing Revalidation service for healthcare providers already enrolled in payer networks to maintain their credentialed status on an ongoing basis.
- Provider Enrollment Service that adds healthcare providers to payer networks and assigns them unique identification numbers for billing purposes, including commercial insurance, Medicare, and Medicaid.
- Contract Renegotiation Negotiation and renegotiation of provider contracts with insurance companies and payers to secure favorable terms.
- EDI Enrollments Electronic Data Interchange enrollment services to set up electronic billing and claims submission with payers.
- IPA Enrollment Independent Practice Association enrollment services for providers joining IPA networks.
- CAQH Credentialing Credentialing services utilizing the Council for Affordable Quality Healthcare universal provider database, including enrollment and ongoing maintenance of CAQH profiles.
- Medicare/Medicaid Enrollment Provider enrollment services with Medicare and Medicaid programs to enable billing for government program patients.
- Medical License Processing Assistance with obtaining and maintaining medical licenses for healthcare providers.
- Hospital Privileges Assistance Support services for obtaining hospital privileges and credentials for affiliated facilities on behalf of providers.
- Behavioral Health Credentialing Specialized credentialing services for behavioral and mental health providers.
- Healthcare Administration Services Broader administrative services supporting healthcare provider operations and practice management, including data integrity, updates/changes, follow-ups, compliance with NCQA and DHFS, and ongoing maintenance of provider credentials.
Quantifiable outcome
- Credentialing process takes 60-120 days depending on payer requirements and documentation completeness
- +2 more outcomes
Companies that use Credentialing & Enrollment
Customer profileSegments10 records
Ideal customer profiles3 records
Credentialing & Enrollment technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature2 records
Credentialing & Enrollment partnerships and signals
Strategic signalScale indicators4 records
Recent moves4 records
Expansion highlights5 records
Credentialing & Enrollment competitors and assessment
Company assessmentBroad incumbents
- HealthStream: HealthStream is a publicly traded healthcare workforce solutions provider with credentialing, learning and staff scheduling products. Its Provider Credentialing solutions compete with this company's service offering, albeit bundled into a much broader enterprise portfolio.
- CAQH (Council for Affordable Quality Healthcare): CAQH runs the ProView universal provider data system that sits at the center of US payer credentialing workflows. As the industry standard infrastructure, CAQH is both a partner (companies submit data on behalf of providers) and a competitive incumbent shaping how credentialing and enrollment are delivered at scale.
Emerging players
- ProviderTrust: ProviderTrust delivers credentialing, exclusion monitoring, and provider data verification SaaS to payers and provider organizations. It targets an overlapping customer set with technology-first credentialing workflows, representing a newer SaaS competitor to traditional services providers.
- QGenda: QGenda has expanded from physician scheduling into credentialing and workforce management for healthcare organizations. Its provider-credentialing module competes for the same mid-market provider customers seeking to consolidate administrative vendors.
Direct peers
- VerityStream: VerityStream (now a symplr company) provides credentialing, privileging and enrollment SaaS for hospitals and healthcare systems. It directly overlaps with this company's medical credentialing, payer enrollment and re-credentialing services, but delivers them primarily as enterprise software rather than outsourced professional services.
- symplr: symplr is a leading healthcare governance, risk and compliance SaaS platform with a flagship credentialing and provider data management suite (formerly known as CredentialStream/Verge). It competes head-on with Credentialing & Enrollment's core offering by automating payer enrollment, primary source verification and re-credentialing for hospitals and large provider groups.
- MedTrainer: MedTrainer offers a unified healthcare compliance platform that bundles credentialing, provider enrollment, training and compliance. It targets the same SMB-to-mid-market provider audience as Credentialing & Enrollment and competes for the same technology-enabled credentialing budgets.
- IntelliSoft: IntelliSoft provides credentialing, payer enrollment and contract management services and software to healthcare organizations of all sizes. Its service-led, tech-supported delivery model closely mirrors Credentialing & Enrollment's professional services plus portal approach.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights5 records
Customer concentration
Credentialing & Enrollment compliance and trust
Trust signalCompliance1 record
Credentialing & Enrollment financial estimates
Financial estimateRevenue estimate
Valuation estimate
Credentialing & Enrollment leadership team
Management profileNumber of profiles
Credentialing & Enrollment funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Credentialing & Enrollment M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Credentialing & Enrollment
What does Credentialing & Enrollment do?
Credentialing & Enrollment provides outsourced medical credentialing and payer enrollment services for healthcare providers, including initial credentialing, re-credentialing, Medicare/Medicaid enrollment, CAQH profile management, EDI enrollments, IPA enrollment, hospital privileges assistance, contract renegotiation, and ongoing maintenance of provider data. A dedicated team handles documentation collection, payer submissions, follow-ups, and periodic updates on behalf of solo practices, group practices, hospitals, HMOs, home health agencies, ambulatory surgical centers, diagnostic and imaging centers, insurance companies, and government agencies.
Is Credentialing & Enrollment a public or private company?
Credentialing & Enrollment is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Credentialing & Enrollment founded?
Credentialing & Enrollment was founded in 2014. It employs 51 to 100 people.
Where is Credentialing & Enrollment based?
Credentialing & Enrollment is headquartered in Rawalpindi, Pakistan, in the Asia region.
How does Credentialing & Enrollment make money?
Six revenue lines are on record. Provider Credentialing Services are the primary driver. The others are medical License Processing, CAQH Credentialing, medicare/Medicaid Enrollment, EDI Enrollments and hospital Privileges Assistance.
Who are Credentialing & Enrollment's main competitors?
Broad incumbents on record are HealthStream and CAQH (Council for Affordable Quality Healthcare). Emerging players are ProviderTrust and QGenda. Direct peers are VerityStream, symplr, MedTrainer and IntelliSoft.
Does Credentialing & Enrollment have an API?
No public API is recorded for Credentialing & Enrollment.
What industry is Credentialing & Enrollment in?
Credentialing & Enrollment's product category is Healthcare Credentialing & Provider Enrollment Services. Its primary akta.pro industry code is HLACACAM, Provider Credentialing & Enrollment (Payer Contracting Ops), with a secondary code of BPAAAFAI, Provider Network, Credentialing & Contracting Support. Its SIC code is 6411.