Credentialing delays are expensive: a provider who isn’t enrolled can see patients, but the practice often can’t bill for those visits. Most delays come from missing or inconsistent information. Gather everything below before the first application goes out.
Identifiers and accounts
- Individual (Type 1) NPI and, for groups, organizational (Type 2) NPI
- Correct taxonomy codes for the provider and the group
- CAQH ProView profile, completed and attested, with payers authorized to view it
- PECOS account for Medicare enrollment
- State Medicaid provider portal account
- Group tax ID (EIN) with IRS confirmation letter and a signed W-9
Provider documents
- Current CV in month/year format, with any gap longer than six months explained
- State medical or professional license(s)
- DEA registration and state controlled-substance registration, if applicable
- Board certification or eligibility
- Malpractice insurance certificate and claims history
- Education, training and hospital privilege details
- Government-issued photo ID
Practice details
- Practice locations, phone numbers and hours, exactly as they should appear in directories
- Billing and pay-to address
- Bank details for EFT enrollment, plus ERA enrollment with each payer
Mistakes that slow everything down
- Names, addresses or dates that don’t match across CAQH, NPPES and applications
- CAQH attestation lapsing (re-attest every 120 days)
- Unexplained CV gaps
- Starting enrollment too late. Begin 90–120 days before the provider’s start date
- Not tracking re-credentialing dates, typically every three years
ClaimEdge RCM Solutions LLC manages enrollment, CAQH upkeep and re-credentialing with a live tracker for every provider. See our credentialing service.
