Start a Healthcare Credentialing Automation Service

It sounds too complex, so almost nobody enters; the practices that need it are drowning in payer paperwork with no in-house help.

1. 1

   Learn the credentialing workflow cold

   Master CAQH ProView, Medicare PECOS, your state Medicaid portal, and commercial payer enrollment. The whole business is knowing which form goes where and chasing it until it clears.

2. 2

   Pick one practice type

   Behavioral health and solo physician practices are the sweet spot: constant enrollment needs, no in-house credentialing staff, and simpler payer mixes to learn on.

3. 3

   Set up the compliance basics

   Form an LLC, get E&O insurance, and have a Business Associate Agreement template ready, since you will handle provider data that practices treat as sensitive.

4. 4

   Price per provider, per payer

   Common structures: $200 to $500 per payer enrollment, plus a monthly maintenance fee per provider for re-credentialing and CAQH re-attestations. The maintenance fee is your recurring revenue.

5. 5

   Get your first practice

   Ask medical billers and practice management consultants for referrals; they see credentialing pain daily and do not want the work. Practice manager groups and MGMA communities are full of buyers.

6. 6

   Deliver and build the calendar

   Complete the first enrollments, document real timelines, and set up a re-credentialing calendar for every provider. That calendar is what turns one-off projects into clients who never leave.