Credentialing & Enrollment Services in Rhode Island

CapitalMed Solutions offers comprehensive credentialing and provider enrollment services for healthcare professionals across Rhode Island. Our experts streamline the process of joining state Medicaid, Medicare, and top private payers—ensuring full compliance, reduced denials, and faster reimbursements.

Why Rhode Island Providers Rely on Our Credentialing & Enrollment Services?

Expertise in Rhode Island Medicaid (EOHHS): Our team is well-versed in the Rhode Island Executive Office of Health and Human Services (EOHHS) enrollment process—managing provider applications, screenings, and revalidations through the state’s MMIS portal to ensure timely and compliant credentialing.

End-to-End Credentialing & Contracting: We manage CAQH, Medicare PECOS, and EOHHS enrollments, as well as commercial payer contracting—helping providers join networks faster and maintain uninterrupted billing.

Local Expertise Across Rhode Island: Whether you serve patients in Providence, Warwick, Cranston, Pawtucket, Woonsocket, or Newport, we customize our approach to each area’s payer landscape and healthcare system.

Complete Credentialing Support: From first-time enrollments to revalidations, we handle NPI and taxonomy updates, NPDB checks, license verifications, and portal follow-ups—so you can stay focused on delivering care.

Credentialing & Enrollment Services We Offer in Rhode Island

At CapitalMed Solutions, a trusted medical billing services company, we provide full-scale credentialing and enrollment support to healthcare providers across all specialties in Rhode Island.

Whether your needs are national or Rhode Island–specific, our team ensures accurate, compliant, and timely applications—reducing payer rejections and accelerating your revenue cycle. As a trusted partner for Medical Billing Services in Rhode Island, we help practices streamline credentialing and improve cash flow through efficient payer enrollment.

Our Credentialing & Enrollment Process in Rhode Island

Identify provider type (individual, group, FQHC, clinic) and determine enrollment pathways—Medi‑Cal FFS via PED/PAVE or Managed Care Plans.

Gather NPI, CA license, W-9, malpractice proof, and set up CAQH and PECOS profiles.

Submit applications via PAVE for Fee-for-Service Medi-Cal, and to MCOs as required.

Conduct primary source verification, monitor application status, and respond to DHCS or plan feedback.

Confirm Medi-Cal and MCO paneling, provider IDs, and enable EFT or EDI billing setup.

Manage periodic revalidations, CAQH attestations, and portal updates to maintain billing capability.

Benefits of Choosing Us for Credentialing Services in Rhode Island

  • Faster Enrollment & Reimbursement: Navigating PED and PAVE with precision accelerates reimbursement timelines.
  • Reduced Administrative Hassle: Outsource complex credentialing tasks and allow your team to focus on patient care.
  • Regulatory Compliance: We stay current with DHCS, DMHC, and Medi-Cal managed care rules.
  • Seamless Managed Care Access: Panel with Medi-Cal FFS and key MCOs across counties—from the Bay Area to L.A., the Central Valley to San Diego.
  • Stronger Financial Stability: Credentialed status ensures clean claims and smoother cash flow.

Major Insurances Companies

Insurance Networks We Work With for Credentialing in Rhode Island

We collaborate with leading insurance carriers across Rhode Island to help providers gain network participation efficiently and maintain compliance.

humana Credentialing & Enrollment Services in Rhode Island
aetna Credentialing & Enrollment Services in Rhode Island
Cigna Credentialing & Enrollment Services in Rhode Island
United Health Care Credentialing & Enrollment Services in Rhode Island
Medicare-Logo Credentialing & Enrollment Services in Rhode Island
Harvard Pilgrim Health Care Credentialing & Enrollment Services in Rhode Island
Tufts Health Plan Credentialing & Enrollment Services in Rhode Island
Neighborhood Health Plan of Rhode Island Credentialing & Enrollment Services in Rhode Island
Rhode Island Medicaid Credentialing & Enrollment Services in Rhode Island
BCBS Credentialing & Enrollment Services in Rhode Island

Ready to Simplify Credentialing in Rhode Island?

Let CapitalMed Solutions handle your credentialing and enrollment process. We help Rhode Island providers stay compliant, get credentialed faster, and start billing without delays.

Working Hours

Monday – Friday 09 AM To 05 PM

Our Location

77 Sugarcreek Blvd Suite 600, Sugar Land, TX 77478