Payer Network Experience

We know how each payer likes their paperwork

Every major payer has its own quirks, portals, and turnaround habits. We file across government programs, commercial payers, IPAs/TPAs, behavioral health carve-outs, and workers' compensation networks.

Medicare (PECOS)CMS-855 filings

Federal program enrollment via PECOS, required before billing Medicare Part A/B for any provider type.

Standard federal Medicare provider enrollment (CMS-855I/855B) plus PECOS account setup, revalidation cycle tracking, and reassignment of benefits filings.

Ask us about Medicare (PECOS) enrollment →
State MedicaidAll 50 states

State-run programs with their own portals, timelines, and fee-for-service or managed-care rules.

Each state runs its own Medicaid enrollment system with different documentation and revalidation cycles — we file and track state-specific Medicaid enrollment in every state you operate.

Ask us about State Medicaid enrollment →
TRICAREMilitary health

Coverage for active-duty service members, retirees, and their families.

TRICARE enrollment requires a separate network agreement (TRICARE East or West region) in addition to standard credentialing — we manage the region-specific application.

Ask us about TRICARE enrollment →
UnitedHealthcareCommercial & Medicare Advantage

The largest commercial payer nationally, with a high-volume, portal-based enrollment process.

UnitedHealthcare enrollment runs through its own provider portal (UHCprovider.com) with typical review timelines on the longer end of the 90-120 day industry range.

Ask us about UnitedHealthcare enrollment →
Aetna (CVS Health)Commercial

Enrollment tied to CAQH ProView, with a separate credentialing committee review step.

Aetna pulls primarily from CAQH but still requires a direct participation application and periodic committee-level re-review.

Ask us about Aetna (CVS Health) enrollment →
CignaCommercial

National commercial network with regional network-adequacy considerations.

Cigna enrollment can be affected by regional network caps in saturated specialties or ZIP codes — timing the application matters.

Ask us about Cigna enrollment →
Elevance Health (Anthem)BCBS

Operates Anthem-branded Blue Cross Blue Shield plans across multiple states.

Enrollment differs by the specific state Anthem plan, since Blue Cross Blue Shield is a federation of separately-run regional entities.

Ask us about Elevance Health (Anthem) enrollment →
HumanaMedicare Advantage

Heavily weighted toward Medicare Advantage plan participation.

Humana enrollment is closely tied to Medicare Advantage network adequacy needs — enrollment timing can vary seasonally around open enrollment.

Ask us about Humana enrollment →
Independent Practice Associations (IPAs)Regional networks

Physician-owned networks that negotiate collectively with payers on behalf of member practices.

IPA enrollment can open doors to better negotiated rates than direct payer contracting, but requires separate IPA-level credentialing on top of standard payer enrollment.

Ask us about Independent Practice Associations (IPAs) enrollment →
Third-Party Administrators (TPAs)Self-funded plans

Administrators for self-funded employer health plans, common in workers' comp and ERISA plans.

TPA enrollment is often overlooked but required separately to get paid on claims administered through self-funded employer plans.

Ask us about Third-Party Administrators (TPAs) enrollment →
Optum Behavioral HealthBH carve-out

UnitedHealthcare's behavioral health network, enrolled separately from the medical plan.

Optum Behavioral Health requires its own enrollment even for providers already in-network with UnitedHealthcare's medical plan.

Ask us about Optum Behavioral Health enrollment →
Carelon Behavioral HealthBH carve-out

Elevance Health's behavioral health network (formerly Beacon Health Options).

Carelon manages behavioral health for multiple Anthem/BCBS state plans under one enrollment process.

Ask us about Carelon Behavioral Health enrollment →
Magellan HealthcareBH carve-out

A major standalone behavioral health managed care organization.

Magellan contracts directly with employers and health plans as a dedicated behavioral health carve-out administrator.

Ask us about Magellan Healthcare enrollment →
State Workers' Comp NetworksState-regulated

Every state runs its own workers' compensation medical network rules.

Workers' comp enrollment and fee schedules are set at the state level — we file according to the specific state's workers' comp board requirements.

Ask us about State Workers' Comp Networks enrollment →
Managed Care Organizations (MCOs)Workers' comp

Third-party networks that manage workers' comp claims on behalf of insurers.

MCO enrollment is a separate credentialing step from standard commercial enrollment, specific to occupational injury and workers' comp billing.

Ask us about Managed Care Organizations (MCOs) enrollment →
HCSCBCBS regional plans

Operates Blue Cross Blue Shield plans across Illinois, Texas, Oklahoma, New Mexico, and Montana.

HCSC enrollment covers five state-specific BCBS plans under one parent organization, each with its own provider network rules.

Ask us about HCSC enrollment →
Centene / AmbetterMarketplace & Medicaid

One of the largest Medicaid managed-care and ACA Marketplace insurers.

Centene operates both Medicaid managed care and Marketplace (Ambetter) plans, often requiring separate enrollment for each program.

Ask us about Centene / Ambetter enrollment →
Molina HealthcareMedicaid & Medicare

Focused on government-sponsored Medicaid and Medicare Advantage plans.

Molina's enrollment process is closely tied to state Medicaid managed-care contracts, which vary by state.

Ask us about Molina Healthcare enrollment →
Kaiser PermanenteIntegrated network

A closed, integrated system — enrollment works differently than open commercial networks.

Kaiser's integrated model means enrollment (where open to outside providers) follows a different process than typical open-network payers.

Ask us about Kaiser Permanente enrollment →
Regional & local plansState-specific

Smaller regional insurers that matter significantly in specific local markets.

Regional plans vary enormously by state and market — we identify and enroll with the regional plans that matter most in your specific service area.

Ask us about Regional & local plans enrollment →

Credzonic does not own or operate any payer network. We are an independent credentialing and enrollment service that helps you get contracted with the payers above.

Not sure which payers to prioritize?

We'll map the right payer order for your specialty and market during your free audit.