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Provider Credentialing Checklist

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Provider Credentialing & CAQH Prep Checklist

Step-by-step checklist to streamline your provider enrollment, CAQH registration, and commercial payer credentialing workflows without revenue delays.

Pre-requisites & Core Documentation

Gather these documents in PDF format before initiating any credentialing requests. Ensure expiration dates are > 60 days out.

Active State Medical License
Ensure full, unrestricted license is verified in your state registry.
Active DEA Certificate
Federal DEA registration matches the primary practice physical location.
NPI Registry Check (NPPES)
Type I NPI (Individual) and Type II NPI (Group) details align with taxonomy.
Board Certifications
Specialty board certifications certificates and training history.
Professional Liability Insurance (COI)
Certificate of insurance showing malpractice coverage limits ($1M/$3M standard).
Current CV (Month/Year Format)
Must detail professional experience with NO employment gaps exceeding 30 days.

CAQH ProView Registration

Nearly all major commercial payers use CAQH as the single repository. Keeping this 100% complete avoids document rejects.

Acquire CAQH Provider ID
Register with CAQH ProView and retrieve your unique provider profile number.
Complete 13 Profile Sections
Fill out education, practice locations, disclosures, affiliations, and specialties.
Upload Support Documents
Upload signed W-9, Malpractice Certificate, State License, and DEA profile.
Authorize Payer Access
Set sharing settings to "Global" or specifically select targeted commercial plans.
Initial Profile Attestation
Digitally sign and attest. Audit check: CAQH status must read "Attested".

Payer Contracting & Enrollment

Submit enrollment requests directly to your targeted networks. Ensure tax IDs are registered correctly.

Medicare Enrollment (PECOS)
Submit form CMS-855I (Individual) and/or CMS-855B (Group) through the online PECOS system.
Medicaid Enrollment (State Portal)
Submit application through your state-specific Medicaid enrollment agency.
Submit Commercial Payer Requests
Apply to Aetna, BCBS, Cigna, Humana, and UnitedHealthcare via their contracting panels.
EFT & ERA Electronic Enrollment
Set up Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) for direct deposit.
Payer Directory Verification
Once approved, verify provider name, address, and specialty listing inside payer directories.

Maintenance & Expiration Tracking

Keep credentialing active. One expired license will trigger instant claim rejections and block payer payments.

Attest CAQH Profile Every 120 Days
Set calendar notifications. Attest profile details to keep it available to insurance payers.
Track Expiration Schedules
Monitor expiration dates for State License, DEA, Board Cert, and Malpractice Insurance.
Update Payer Contracts on Facility Moves
Notify contracted payers at least 60 days before moving office physical locations.
Respond to Re-Credentialing Cycles
Complete re-credentialing packets every 3 years as mandated by commercial networks.
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Readiness Score
Not Started. Start checking off credentials.

Average Payer Approval Timelines

Payer Enrollment Window
Medicare 30 - 45 Days
Medicaid 45 - 60 Days
BCBS Plans 60 - 90 Days
Aetna / Cigna 90 - 120 Days
UnitedHealthcare 90 - 120 Days

Need Help? Get a Free Provider Enrollment Audit

Let our credentialing specialists review your CAQH profile and active payer rosters to locate contract gaps.

Rosters submitted! An RCM specialist will contact you within 24 hours.

Why Credentialing Is the #1 Cause of Lost Revenue for New Providers

Every day a provider is not credentialed with a payer is a day that payer’s patients must be billed as out-of-network, or worse, written off entirely. For an average-volume primary care provider, the opportunity cost of a 90-day credentialing delay is roughly $45,000 in collectible revenue. For specialists, it’s significantly more.

The checklist eliminates the three most common delays: incomplete CAQH data (caught by our pre-submission QA), missing supporting documents at the time of payer application (caught by our document matrix), and failure to follow up at the 30/60/90-day marks (tracked in our provided spreadsheet).

Need credentialing handled for you? Revenue Synergy’s in-house credentialing team averages 45-day enrollment with a 98% first-submission acceptance rate.

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