We have deliberately left out dollar figures. Rates vary by region, specialty, payer mix and level of service, and any number we printed would be wrong for many readers. Instead, this guide covers the pricing models agencies use, what each one rewards, and how to make whichever you choose work.
The common pricing models
| Model | How it works | Works well when | Watch out for |
|---|---|---|---|
| Per application | A fee for each payer enrollment, sometimes priced differently for Medicare, Medicaid and commercial plans. | Work is project-based, such as a new provider joining six payers. | Applications that drag on for months with many follow-ups for the same fee. |
| Per provider package | One fee to enroll a provider with an agreed list of payers. | Clients want a single number to budget. | Clients adding payers to the package later; define the list. |
| Monthly maintenance per provider | A recurring fee per enrolled provider for CAQH, monitoring, recredentialing and updates. | You want predictable, recurring revenue after enrollment. | Unclear scope; list exactly what maintenance covers. |
| Retainer | A fixed monthly fee for a defined volume or for all credentialing for a practice. | Larger clients with steady, ongoing needs. | Volume creeping above what the retainer was priced for. |
| Hourly or project | Time-based or fixed-price work for clean-ups, audits or unusual requests. | The scope is hard to predict, like untangling years of old enrollments. | Clients find hourly billing hard to budget. |
| Bundled with billing | Credentialing included in, or added to, a billing company’s fee, which may be a percentage of collections. | Billing companies that want fewer enrollment-related denials. | Credentialing effort hidden inside a collections percentage. |
What drives the effort behind a price
Whatever the model, your price should reflect the work. The factors that change the effort most:
- Payer mix. Government programs, managed care plans and commercial payers each have their own forms, portals and timelines.
- States. Each state Medicaid program has its own enrollment and revalidation schedule. Multi-state providers, common in telehealth, multiply the work.
- Provider type and readiness. A provider with a current CAQH profile and complete documents is far faster than one starting from scratch.
- Group vs individual enrollment. A new practice may need group enrollments and contracts before individual providers can be linked.
- Client responsiveness. The biggest variable you do not control. Price and contract for it.
- Urgency. Rush work displaces other work; many agencies price it separately.
Define the scope in writing
Most pricing disputes are scope disputes. For each fee, write down:
- Which payers, providers and locations are included
- Which tasks are included (application, follow-up, CAQH, recredentialing, updates)
- What the client must provide, and the expected turnaround
- What is not included, such as contract rate negotiation or payer application fees
- How additional payers, providers or locations are priced
- When fees are due: on signing, on submission, on approval, or monthly
Choosing a model
If most of your work is new enrollments, a per-application or per-provider model keeps pricing tied to visible work. If you want stable revenue, pair it with a monthly maintenance fee per provider once they are enrolled. Billing companies adding credentialing often price it per provider per month so it sits cleanly beside their billing fee.
Whatever you choose, track your own effort. After a few months, your records of how long each payer takes and how many follow-ups an application needs will tell you whether your prices are right.
Invoicing without spreadsheets
Credentik lets you set pricing per billing client, including credentialing per application or per provider per month, billing as a percentage of collections, per claim, flat or hybrid, a one-time setup fee and add-ons, and turns each month’s activity into an itemized invoice. See agency invoicing.