If you’re a new provider, opening a practice or adding a clinician to your group, insurance credentialing is usually the longest step between you and getting paid. Here’s what to expect and how to keep it moving.
The typical timeline
Most commercial payers take about 60 to 120 days from a complete application to an effective date, and some take longer. Medicare enrollment is often quicker. State Medicaid and Medicaid managed care plans vary widely by state.
Those timelines start from a complete application. Missing documents, an outdated CAQH profile or mismatched information are the most common reasons it drags on for months.
What you need before you start
- An individual NPI, plus a group NPI if billing under a group
- Active state license and, where relevant, DEA registration
- Malpractice insurance certificate
- Practice tax ID and W-9
- CV with full work history, with any gaps over six months explained
- Board certification, if applicable
CAQH comes first
Most commercial payers pull your information from CAQH ProView. Before applying anywhere, make sure your CAQH profile is complete, documents are uploaded, the payers are authorized to view it, and it’s attested. You’ll need to re-attest every 120 days, or payers may treat the profile as out of date.
Why credentialing gets delayed
- Information that doesn’t match across CAQH, NPPES and the application, such as addresses or taxonomy
- Expired documents uploaded to CAQH
- Payers not authorized to view the CAQH profile
- No follow-up, so an application sits waiting for one missing item
- Panels that are closed to new providers in your specialty or area
Follow up every two weeks. Applications rarely move on their own. Regular calls catch missing items early and keep your file active.
Can you see patients while you wait?
You can, but claims for those visits may be denied or paid as out-of-network until your effective date. Some payers allow a retroactive effective date; many don’t. If you’re joining a group, ask whether you can be added to the group contract, and confirm with each payer before billing.
After you’re approved
Confirm your effective date and fee schedule with each payer, load them into your billing system, and set reminders for CAQH re-attestation, license renewals and payer re-credentialing, usually every three years.
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