Healthcare Credentialing Frequently Asked Questions
Answers to the most common questions about provider credentialing, payer enrollment, and working with Niyutsa Technologies.
General
What is healthcare credentialing?
Healthcare credentialing is the process by which insurance payers and healthcare facilities verify a provider's qualifications, training, licensure, and background before allowing them to practice or bill within their network.
How long does credentialing take?
Timelines vary by payer: Medicare takes 60 to 90 days via PECOS, Medicaid takes 30 to 120 days by state, and commercial payers range from 45 to 120 days. Our proactive process reduces these timelines by an average of 25%.
CAQH
What is CAQH ProView?
CAQH ProView is a centralized database used by more than 1,000 health plans to collect provider credentials. Providers enter information once and authorize payers to access it rather than completing separate applications for each insurer.
How often does CAQH need to be updated?
CAQH requires re-attestation every 120 days. Failure to re-attest marks the profile inactive, blocking payer access and halting any pending credentialing applications.
Medicare
What is a PTAN?
A PTAN (Provider Transaction Access Number) is the unique Medicare identifier issued by CMS after enrollment approval. It is required to submit Medicare Part B claims.
Do I need PECOS for Medicare Advantage?
No. PECOS enrollment establishes Medicare Part B status. Medicare Advantage credentialing requires separate applications with each Medicare Advantage Organization.
Billing Companies
Can billing companies offer credentialing to their clients?
Yes. Many billing companies partner with Niyutsa Technologies to offer white-label credentialing and payer enrollment to their clients at partner pricing, adding a new revenue line without building internal credentialing staff.
India Partners
Do you partner with India-based RCM companies?
Yes. Our Delhi office at 622A/5A Kalkaji, South Delhi supports partnerships with India-based medical billing and RCM companies that serve US healthcare clients. Contact +91 8076689768 for India-specific partnership inquiries.