Best Credentialing Companies in New York for Healthcare Providers
All New York providers should have the opportunity to receive fast, reliable, and verified credentialing through Credex Healthcare. That’s why we claim to be the top credentialing company in the state. Our team works hard to ensure doctors, therapists, and clinics are enrolled by insurance payers quickly and accurately. If you’re looking for the most suitable credentialing firms in New York for Healthcare Providers in 2025, this compilation is for you.
Importance of Credentialing in New York’s Healthcare Sector
Healthcare providers in New York place great importance on credentialing. It is essential to have it to work with insurance companies, earn revenue from services, treat hospitalized patients in many healthcare facilities, and, in some cases, it is even legally required. For individual physicians or growing clinics, credentialing connects you with the payers your patients use.
New York has a competitive healthcare market with patients enrolled in numerous insurance plans; therefore, credentialing with major payers like Medicaid, Medicare, and private insurance is crucial. This is because state regulations are very strict, especially concerning issues related to managed care plans and public health options.
Key Regulations to Know in New York
New York enjoys special credentialing regulations that distinguish it from other states. For example:
- In New York, Medicaid is part of the enrollment process using the eMedNY portal.
- The majority of the commercial payers in the state also demand that providers maintain the current CAQH profile.
- It will be required to be recertified in 2-3 years.
- Many payers follow the guidelines of the New York State Department of Health.
Failing to meet deadlines or committing mistakes on your application can cause a delay or rejection. That is why numerous providers prefer to cooperate with credentialing companies for Healthcare Providers that understand these local rules.
Top Credentialing Companies in New York for Healthcare Providers
Now, we will take a closer look at the top credentialing firms in New York in 2025. These companies help doctors, therapists, clinics, and other healthcare providers with credentialing and staying compliant with state and insurance regulations.
1. Credex Healthcare
Credex Healthcare is the leading credentialing company in New York for Healthcare Providers, which handles both ends, including CAQH setup, PECOS registration, commercial insurance registration, re-credentialing, and callbacks. They are experts in New York regulations. They make sure your applications are complete, correct, and submitted promptly. Credentialing with Medicaid, Medicare, or private payers is simple, no matter which option you select.
2. StatMedCare Solutions
StatMedCare is a physician credentialing service provider in New York. They collaborate with doctors and nurse practitioners, and group practices. They have a high turnaround time and a credentialing team.
3. Medwave Healthcare Staffing & Credentialing
Medwave offers staffing and credentialing. They provide services to the New York area and collaborate with hospitals and outpatient clinics. They process CAQH, payer enrollment, and license verification in their credentialing department.
4. Credentialing.com
The services offered by this company are CAQH updates, enrollment in the insurance panel, and credentialing with Medicare/Medicaid. They are a support system covering the whole nation, and they have providers in New York. They assist in NPI registration and provider directories, too.
5. PracticeForces
PracticeForces is a big company in revenue cycle management as well as credentialing. They cater to New York and nationwide providers. Their credentialing service has a relationship with more than 50 insurance payers and does everything with documentation, follow-ups, and revalidation.
6. M-Scribe Credentialing Services
M-Scribe offers solutions to New York-based providers in terms of credentialing, payer contracting, and compliance. They have a reputation for assisting mental health providers and individual practitioners. Their professionals deal with Medicaid credentialing and re-credentialing as well.
7. TriZetto Provider Solutions (TPX)
TriZetto offers credentialing software, tools, and services to larger medical groups and hospitals. Numerous providers in New York use TPX because of the complicated credentialing schedule and multi-payer enrollment.
8. Synergy Billing Credentialing Services
Synergy Billing provides revenue cycle and credentialing services to health centers and clinics within New York. They are familiar with the FQHC credentialing and compliance regulations of the New York Department of Health.
9. The MedCycle Solutions
MedCycle has a full range of credentialing services in New York for providers. They collaborate with behavioral health professionals, individual practices, and medical groups. They are concerned with precision and payer contact.
10. MedUSA Healthcare Services
MedUSA is a credentialing and medical billing firm serving providers. Their services facilitate the completion of CAQH profiles by their clients in New York, their enrollment in Medicaid and Medicare, and their in-networking with the leading commercial insurers.
What to Expect When Credentialing in New York for Healthcare Providers
In New York, it is time-consuming to get a credential. The majority of the payers carry the procedure within 60-120 days. In the case of Medicaid, the application may take even a longer period if there are errors in the application forms or if other documents are left out. The process of enrolling in Medicare has to pass through PECOS and takes some weeks.
You are required to submit:
– Educational and training demonstration
– Board certification
– Malpractice insurance
– DEA registration and licensure
– An updated CAQH profile
In case you do not have a document that is current document or a document that is not in place, your application will be delayed or even rejected. These problems can be prevented by enlisting the service of a professional credentialing firm.
Remote vs Local Credentialing Companies for Healthcare Providers: What’s Better for NY Providers?
Local and national credentialing firms have their advantages, yet in the case of New York providers, a company would have to be familiar with the rules of the state. Local companies usually know New York payers, Medicaid reimbursement policies, and deadlines in and out. Nevertheless, localized experience applies to national enterprises that bring together local know-how and scalable technology, and experienced teams, such as Credex Healthcare.
In the selection, ensure that the company:
- Processed New York Medicaid and Medicare enrolment
- Understands the local insurance payers
- Is able to support CAQH and PECOS profiles
- Provides quick response with compliance aid
Conclusion
Choosing the right credentialing company in New York for Healthcare Providers can save you time, money, and stress. These companies help providers complete all necessary steps, whether it’s Medicaid enrollment or commercial panel contracting. However, if you want the fastest and most accurate credentialing service in New York, trust Credex Healthcare.
In an effort to begin the process, why not give us a call today and have Credex Healthcare do the lifting?
FAQs
Are there different New York credentialing rules?
Yes. New York has specific Medicaid enrollment standards, credentialing schedules, and managed care programs. Other delays can be avoided by working with a firm familiar with New York’s rules.
What are the NY credentialing delays?
Delays can occur due to missing documents, expired licenses, updates in CAQH profiles, or changes in payer policies. A thorough application process and consistent follow-up are essential to stay on track.
What is the Medicaid credentialing provision time in NY?
The credentialing process for New York Medicaid can take anywhere from 90 to 150 days, depending on the type of providers and the quality of the applications. The timeline might be longer due to errors or missing items.
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Testimonials
As a Homecare agency, navigating credentialing and enrollment can be a headache, but Credex Healthcare made it simple and straightforward. They took care of everything from our NPI management to PECOS enrollment, ensuring compliance at every step. Their expertise in primary source verification and network research helped us expand our network, allowing us to provide care to more patients. Highly recommend!
Homecare Agency Owner
Credex Healthcare has been an invaluable partner for our multi-specialty group practice. They handled all our credentialing and enrollment needs, ensuring every provider was up-to-date across insurance networks and credentialing portals like CAQH and PECOS. Their ability to track and manage multiple providers’ licenses and certifications has saved us a tremendous amount of time and reduced our administrative burden.
Pediatric Group
Running a lab comes with its own set of compliance challenges, but Credex Healthcare has taken care of it all. They managed our CLIA waiver, credentialing, and enrollment processes, ensuring that we met every regulatory requirement. Their attention to detail and ability to handle complex credentialing issues has allowed us to focus on our operations without worrying about missing deadlines or facing compliance issues. Exceptional service!
Lab Director
Credex Healthcare has been a game-changer for our HomeHealth agency. They managed our credentialing process from start to finish, ensuring all our licenses, DEA registrations, and CAQH profiles were up to date. Their expiration tracking system is incredibly helpful in keeping everything in check. Thanks to them, we can focus on delivering quality care to our patients without worrying about administrative hurdles.
HomeHealth agency Owner
Credex Healthcare has been amazing to work with. As a Nurse Practitioner, they took care of everything, from managing my NPI and PECOS enrollment to handling all my licensing and revalidation requirements. Their support has allowed me to concentrate fully on patient care, and their thorough primary source verification ensured that my credentials were always accurate and up to date. I couldn’t ask for a better partner!
Nurse Practitioner (NP)
I’ve had an outstanding experience with Credex Healthcare. They took over my credentialing, managed my CAQH profile, and handled my DEA registration with ease. Their team made sure my practice stayed compliant and helped me with network research and application follow-up. I don’t know what I would do without them handling all the administrative tasks!
