📋 Medical Credentialing Checklist

Complete Credentialing Checklist

• Gather Required Documents

  Medical license, DEA certificate, NPI number, malpractice insurance, board certification, CV, education transcripts, residency completion certificates

• Create CAQH ProView Profile

  Register at caqh.org, complete all sections including practice information, malpractice history, work history, and liability coverage. Attest to all information.

• Enroll in Medicare (PECOS)

  Complete CMS-855I (individual) or CMS-855B (group) via PECOS portal. Include NPI, taxonomy code, practice location, and ownership information.

• Enroll in Medicaid

  Each state has different requirements. Complete state-specific applications and provide all required documentation. Allow 90-120 days for processing.

• Apply to Commercial Payers

  Submit applications to BCBS, UHC, Aetna, Cigna, and other local payers. Each payer has unique forms and requirements. Track all submission dates.

• Follow Up on Applications

  Call payers every 2 weeks to check status. Respond immediately to any requests for additional information. Document all communications.

• Verify Enrollment Status

  Once approved, verify you're in the payer's system. Test bill a claim to ensure everything is working correctly.

• Set Up Reattestation Reminders

  CAQH requires reattestation every 120 days. Medicare and commercial payers require revalidation every 3-5 years. Set calendar reminders 90 days before expiration.