Credentialing is often the slowest step in adding a new provider, and the delay is expensive. Until a provider is enrolled with a payer, visits with that payer's patients either can't be scheduled or may not be paid. Knowing what drives the timeline helps you plan and avoid the most common delays.
How long does credentialing take?
For most payers, credentialing and enrollment take 60 to 120 days from a complete application to an effective date. Some move faster, and some take considerably longer, especially in busy seasons or in markets where networks are closed to new providers.
- Medicare enrollment through PECOS (using the CMS-855 forms) often takes several weeks to a few months, depending on the Medicare Administrative Contractor and whether the application needs corrections.
- Medicaid timelines vary by state and can include additional screening steps.
- Commercial payers typically take three to four months, and some require separate credentialing and contracting steps.
What happens during credentialing
Payers verify a provider's education, training, licenses, board certification, DEA registration, malpractice coverage, work history and any history of sanctions or claims. Most commercial payers pull this information from the provider's CAQH ProView profile, which must be complete and attested.
The most common causes of delay
- Incomplete applications. A missing signature, document or answer can send an application back to the start.
- An outdated CAQH profile. CAQH profiles must be re-attested every 120 days, and expired documents stop the process.
- Unexplained gaps in work history or a CV that doesn't match the application.
- Expired documents, such as a malpractice certificate or license that renews during the review.
- No follow-up. Applications that nobody checks on can sit in a payer's queue for weeks.
- Closed networks. Some payers aren't accepting new providers in certain specialties or areas, which may require a request or appeal.
How to speed it up
- Start early. Begin credentialing as soon as a new provider signs, ideally 90 to 120 days before the planned start date.
- Gather documents up front. License, DEA, board certification, malpractice certificate, CV with month-and-year dates, and any explanation of gaps.
- Complete and attest CAQH first, and keep it current.
- Submit to every payer at once rather than one at a time.
- Follow up on a schedule. Check the status of each application every week or two and respond to requests immediately.
- Track effective dates. Confirm the effective date for each payer before scheduling that payer's patients.
Don't forget re-credentialing
Credentialing isn't a one-time task. Commercial payers usually re-credential providers about every three years, and Medicare requires revalidation, generally every five years. Missing a deadline can interrupt payments.
If credentialing is holding up your growth, our team can manage applications, CAQH and follow-up for every payer. Learn more about our medical credentialing services.
