Credentialing Management

Cosmos Medical Management (CMM) provides end-to-end credentialing services, ensuring providers are accurately enrolled and maintained with Medicare, Medicaid, and all major commercial, PPO and HMO insurance plans.

We specializes in complete credentialing management, including Medicare and Medicaid  revalidation and commercial insurance enrollment. We monitor deadlines, update CAQH, and maintain payer records to keep your practice fully credentialed and operating smoothly.

Medicare & Medicaid Revalidation Revalidation requires providers to review and update all enrollment information, submit required documentation, and respond to any payer requests before the deadline. The process includes verifying licenses, updating practice details, and completing PECOS or state Medicaid portal submissions to maintain active participation.

Medicare: Medicare requires providers to revalidate their enrollment every 3 years and facilities to revalidate their enrollment every five years.

Medicaid: Most state Medicaid programs require providers and facilities to revalidate every 3–5 years, depending on state rules and provider type.

Commercial Insurance (PPO & HMO) Recredentialing: Commercial plans require providers to update demographic details, licenses, malpractice insurance, and practice information every 2–3 years. The payer reviews the updated file, verifies credentials, and confirms continued network participation.

CAQH Maintenance Providers must keep CAQH profiles current by uploading updated documents, renewing attestations every 90 days, and ensuring all information matches payer records. Many commercial plans rely on CAQH for credentialing and recredentialing decisions.

Missing the deadline can result in deactivation of billing privileges, which stops claim payments until re-enrollment is completed.