Credentialing Enrollment Services

The Center for Health Care Services

Buyer seeks a qualified firm to provide credentialing enrollment services for its professional providers. The contractor will manage enrollment applications, verify credentials, and maintain tracking of licensed professionals across various insurance networks. Services include handling applications for Medicaid, Managed Care, and Private Insurance networks while working with the buyer's reimbursement team. The contractor will provide regular reporting on application status and performance metrics.

• 6/17/2025 - Release Date
• 6/25/2025 - Pre-Submittal Conference
• 7/2/2025 - Final Questions Accepted
• 7/18/2025 - Proposal Due Date

• Must have credentialing specialists trained in payer regulations
• Capability to connect to Electronic Health Record (EHR) systems
• Knowledge of Medicare, Medicaid, and commercial payer enrollment processes
• Experience with CAQH and state-specific forms

• Offer comprehensive credentialing for approximately 250 employees
• Review existing private insurance enrollments and provide PDM platform access
• Handle enrollment applications across Medicaid, Managed Care, and Private Insurance networks
• Verify provider credentials and collect documentation
• Maintain comprehensive roster tracking licensed professionals and payers
• Work with reimbursement team to align payer enrollment with billing
• Address credentialing-related claim denials
• Oversee complete application lifecycle with weekly progress updates
• Connect to CENTER's EHR, myAvatar, and Tejas platforms
• Provide monthly and quarterly performance reports