How to get credentialed with insurance companies
To get credentialed with insurance companies, you get an NPI, build and attest a CAQH profile, enroll in Medicare through PECOS and in your state's Medicaid program, then apply to each private insurer and follow up until it signs a contract with you. Expect 60 to 180 days for most private insurers.
- Get your NPI (and a group NPI if you bill as a practice)
- Complete and attest your CAQH profile
- Enroll in Medicare through PECOS
- Enroll in your state's Medicaid program
- Apply to each private insurer and check its panel is open
- Follow up every 1–2 weeks until you get a contract and effective date
What credentialing actually is
"Getting credentialed" covers two separate things that people often mix up.
- Credentialing is the insurer checking that you are who you say you are: your license, education, training, work history, malpractice insurance and any sanctions. It checks these with the original sources, such as the state board and your schools.
- Contracting is the insurer agreeing to pay you as an in-network provider, at a set fee schedule, from an effective date.
You need both. An insurer can finish credentialing you and still not send a contract, for example when its network is full in your area. Until you have a signed contract and an effective date, its members are out-of-network for you.
Medicare and Medicaid call the same process enrollment. There is no contract to negotiate. You are enrolled at the program's set rates once your application is approved.
What you need before you start
Gather these first. Nearly every application asks for the same set, and a missing item is the most common reason an application sits untouched for weeks.
- Active state license for each state you practice in
- NPI (individual, and group if you have one)
- DEA registration, if you prescribe controlled substances
- Board certification, if you have it
- Malpractice insurance certificate, current
- CV with month and year for every job since training
- Education and training dates and addresses
- W-9 with your practice's Tax ID
- Practice address, phone and hours
- Hospital privileges or a hospitalist arrangement, if required
Check that your name, practice address and specialty are written exactly the same way on your NPI record, license, CAQH profile and W-9. Mismatches are a quiet but common reason insurers send applications back.
The process, step by step
Steps 3 to 5 run at the same time once your NPI and CAQH profile are ready. Times are typical ranges from a complete application.
Step 1: Get your NPI
Your National Provider Identifier is a 10-digit number every insurer uses to identify you. Apply online through NPPES. It is free and usually issued within days. If you will bill as a practice, rather than under your own name, the practice needs its own Type 2 (organization) NPI as well as your Type 1 (individual) NPI.
Choose your taxonomy code carefully. It tells insurers your specialty, and a wrong code can route your application to the wrong network team.
Step 2: Complete and attest your CAQH profile
Most private insurers don't use their own long forms any more. They read your details from CAQH ProView, a shared database. Creating a profile is free for providers. Our CAQH guide covers each section in detail.
- Fill in every section, including work history with no unexplained gaps of more than six months.
- Upload your license, DEA, board certificate, malpractice certificate and CV.
- Authorize each insurer to view your profile. Insurers can't see a profile you haven't released to them, and this step is easy to miss.
- Attest that everything is correct. You must re-attest at least every 120 days (180 in Illinois), or insurers stop treating the profile as current.
Step 3: Enroll in Medicare through PECOS
Apply online in PECOS, Medicare's enrollment system. Individual practitioners use the CMS-855I. A group practice enrolls on the CMS-855B and individual providers reassign their billing to it. Online applications are processed faster than paper ones by your regional Medicare Administrative Contractor (MAC).
Your Medicare effective date is based on the date the MAC receives the application that is later approved, and you can bill for services up to 30 days before that date. That makes it worth sending Medicare early and getting it right the first time. Individual practitioners pay no application fee. Medicare revalidates your enrollment every 5 years. Our Medicare enrollment guide covers the forms and effective dates in detail.
Step 4: Enroll in your state's Medicaid program
Every state runs its own Medicaid enrollment portal, with its own forms and timelines, typically 30 to 90 days. Many states also require you to join each Medicaid managed care plan separately after you are enrolled in the state program, because most Medicaid patients are covered through those plans.
Step 5: Apply to each private insurer
Start from each insurer's "join our network" or provider enrollment page. The process is similar everywhere:
- Ask whether the panel is open for your specialty and location. If it is closed, ask about exceptions (below).
- Submit the request with your NPI, Tax ID and CAQH number, and make sure the insurer is authorized on your CAQH profile.
- Verification. The insurer checks your license, education, sanctions and malpractice history with the original sources.
- Credentialing committee. A committee approves you, usually without any action from you.
- Contract. You receive and sign a participation agreement with a fee schedule. Read it before signing.
- Effective date and loading. The insurer adds you to its system and directory. Don't bill in-network until you have your effective date in writing.
| Insurer | Where to start | Worth knowing |
|---|---|---|
| Blue Cross Blue Shield | Your state's Blue plan | Each state's Blue plan is a separate company with its own process. |
| UnitedHealthcare | UHC provider site | Behavioral health is handled by Optum, not UHC directly. |
| Aetna | Aetna "join our network" | Uses your CAQH profile for most specialties. |
| Cigna | Cigna for health care professionals | Check whether your plan is administered by a partner network in your state. |
| Humana | Humana provider site | Mostly Medicare Advantage and Tricare patients, so credentialing matters most for older patients. |
How long credentialing takes
From a complete application, most private insurers take 60 to 180 days, with 90 to 120 days typical. Medicare is often faster, around 30 to 60 days, and Medicaid varies by state.
What actually decides the timeline is mostly within your control:
- Completeness. An application missing one document doesn't move. Most insurers won't tell you until you call.
- CAQH status. An unattested profile, or one not authorized for that insurer, stops the process.
- Follow-up. Applications that get a call every one to two weeks move faster than ones left alone. Write down every reference number and the name of everyone you speak to.
Start credentialing at least 90 to 120 days before you plan to see insured patients. If you are leaving a job to open a practice, start before you give notice if your contract allows it.
What credentialing costs
| Option | Typical cost | Good fit when |
|---|---|---|
| Do it yourself | No fees for most individual providers. Your time: often 20+ hours across all plans. | You need one or two insurers and have time to follow up. |
| Per-insurer service | $100–$300 per insurer | You need a handful of plans. |
| Full setup package | $1,200–$3,000 per provider | You are opening a practice and need several plans at once. |
| "Free" platforms | A share of every paid claim, often for years | You want them to do your billing too. |
The biggest cost is usually not the fee but lost income. Every month you aren't in-network is a month of insured patients you can't bill, or have to turn away.
Why applications stall or get denied
- CAQH not attested or not authorized for that insurer.
- Mismatched details: a different address, name spelling or specialty on your NPI, license and CAQH.
- Work history gaps over six months with no explanation.
- Expired documents, especially the malpractice certificate, which renews yearly.
- Wrong or missing group link: applying as an individual when you'll bill under a group Tax ID, or the reverse.
- Closed panels in your specialty and county.
- No follow-up. Missing items are often not flagged until someone calls.
If an insurer says its panel is closed
A closed panel is not always final. Ask whether the closure covers your exact specialty and county, and whether the insurer makes exceptions for areas with too few providers, languages you speak, evening or weekend hours, or a sub-specialty in short supply. Put your case in writing. If the answer is still no, ask to join the waitlist and when the network will be reviewed again.
After you're approved: keeping your credentials current
Credentialing doesn't end at approval. Insurers remove providers whose files go out of date. Our recredentialing and revalidation guide covers each cycle in detail.
- Every 120 days: re-attest your CAQH profile.
- Every year: upload renewed malpractice certificates, licenses and DEA registrations before they expire.
- Every 3 years: re-credentialing with each private insurer.
- Every 5 years: Medicare revalidation.
- Any time you move or add a location: update NPPES, CAQH, PECOS and each insurer.
Should you do it yourself or hire help?
Doing it yourself is realistic for one or two insurers, especially Medicare, which is well documented. It gets hard when you need five or more plans at once while also setting up a practice. Each insurer has its own process and follow-up schedule, and a missed request can cost weeks.
If you hire help, check three things. The contracts must be in your own name, NPI and Tax ID. You should know exactly what you'll pay, whether a flat fee or a share of claims, and for how long. And you should get regular written updates with reference numbers, so you can take over at any time.
Want us to handle it?
Credentialers offers medical credentialing services and does all of the above: CAQH, Medicare, Medicaid and up to 5 private insurers for a flat $900 per provider, with a weekly status email until each one decides.
Start credentialingCommon questions
How long does it take to get credentialed with insurance companies?
Most private insurers take 60 to 180 days from a complete application, with 90 to 120 days typical. Medicare often takes 30 to 60 days and state Medicaid programs 30 to 90 days. Incomplete applications and CAQH profiles that are not attested are the most common causes of delay.
Can I see insured patients before I am credentialed?
You can see them as self-pay or out-of-network patients, but most private insurers will not pay in-network rates for visits before your effective date. Medicare is an exception in part: it can pay for services up to 30 days before the date your approved application was received.
How much does insurance credentialing cost?
Doing it yourself costs nothing in fees for most individual providers: NPI, CAQH and Medicare enrollment for individual practitioners are free. Credentialing services typically charge $100 to $300 per insurer, or $1,200 to $3,000 for a full setup with the main plans.
Do I need a CAQH profile to get credentialed?
Most private insurers require one. They read your education, licenses, work history and malpractice details from CAQH instead of a separate form, so the profile must be complete, attested within the last 120 days, and authorized for each insurer to view.
What if an insurer says its panel is closed?
Ask whether the closure applies to your specialty and county, and whether exceptions are made for underserved areas, languages spoken, evening hours or specialties in short supply. If it stays closed, ask to be put on the waitlist and reapply when the insurer says it will review again.