Individual Credentialing Services for Government Insurance Programs

Government insurance programs such as Medicare, Medicaid, TRICARE, and other federal or state-sponsored healthcare plans often require extensive enrollment processes, specialized portals, additional documentation, and compliance with state-specific regulations. Requirements and enrollment procedures vary significantly by payer and state.

Individual credentialing is required for providers who are newly licensed, joining a practice, being added to an existing group roster, or seeking participation with government insurance programs. Most government payers require providers to complete credentialing and enrollment before services may be billed as an in-network provider.

In certain circumstances, government payers may require providers to complete additional enrollment processes, register through designated government portals, obtain certifications, or enroll as a non-participating provider before claims may be submitted. The Insurance Magician, LLC assists providers in navigating these requirements and completing the necessary enrollment steps.

The Insurance Magician, LLC will assist with the preparation, submission, tracking, and follow-up of credentialing and enrollment applications with participating government insurance programs.

Client Obligations

Initial Consultation

The Client agrees to schedule and attend a 30-minute consultation to determine enrollment goals, identify target insurance programs, and review all required documentation.

Provider Documentation

The Client shall provide the following:

• A current and freshly attested CAQH ProView profile, when applicable.

• A copy of the provider's current state license.

• Proof of current professional liability/malpractice insurance coverage.

• Approval of all required connection requests through applicable third-party enrollment portals, including but not limited to PECOS, IMPACT, Humana Military/TRICARE, Availity, or other payer-designated systems.

• A completed and current Provider Data Summary in PDF format, including all employment history, practice locations, education, training, work history, and professional credentials.

• Copies of all certifications, registrations, and supporting documentation required by the payer.

• Any additional documentation requested by the insurance carrier, government agency, or enrollment contractor during the credentialing process.

Service Fee

Government Individual Credentialing Fee: $495.00

Processing fees may apply.

Important Notice

The Insurance Magician, LLC will use commercially reasonable efforts to prepare, submit, monitor, and follow up on all credentialing and enrollment applications. However, approval, participation status, effective dates, reimbursement rates, network availability, and processing timelines are determined solely by the applicable government agency, payer, or enrollment contractor.

The Insurance Magician, LLC cannot guarantee acceptance into any insurance network, government program, credentialing application, or enrollment request. Furthermore, The Insurance Magician, LLC cannot guarantee specific reimbursement rates, effective dates, panel availability, processing timelines, or approval outcomes.

All fees paid are for professional services rendered and are non-refundable once work has commenced, regardless of the final determination made by the payer, government agency, or enrollment contractor.