Provider Credentialing Checklist

Unrestricted, active license in the state(s) where you will practice. Verify expiration date — many payers reject applications within 90 days of expiry.

Active Drug Enforcement Administration registration for controlled substance prescribing. Must match your practice address.

10-digit NPI number from NPPES. Verify your NPI record is current — incorrect taxonomy codes cause claim denials.

Current board certification from the relevant specialty board (ABMS, AOA, or nursing boards). Include certificate and verification letter.

Official diploma from accredited medical, osteopathic, or nursing program. Some payers require official transcripts.

Official letter confirming completion of all required postgraduate training programs with dates.

Certificate of insurance showing coverage amounts (typically $1M/$3M minimum), policy dates, and covered providers.

Disclosure of all malpractice claims, lawsuits, and settlements. Include case summaries even for dismissed claims.

Chronological CV with no unexplained gaps. Include month/year for all positions. Gaps over 30 days require written explanation.

Copy of valid passport or driver's license for identity verification.

Create or update your CAQH ProView profile with all practice locations, specialties, and credentials. Over 900 health plans pull from CAQH.

Re-attest every 120 days or your profile goes inactive and applications stall.

Electronically attest that all information is accurate and complete. Attestation must be refreshed quarterly.

Provide 3-5 professional references (peers who can attest to clinical competence). Most payers require references from the same specialty.

Letters confirming current and past hospital privileges, including any limitations, voluntary relinquishments, or privilege changes.

Confirm practice name, address, phone, fax, office hours, and ADA accessibility for each service location.

Complete individual applications for each insurance payer. Track submission dates — each payer has different processing timelines.

Start with highest-volume payers. Medicare enrollment averages 60-90 days.

Submit Medicare enrollment application through PECOS. Required before billing Medicare.

Verify that the payer has completed PSV of your license, education, board certification, and training directly with issuing bodies.

The National Practitioner Data Bank query is part of every credentialing process. Ensure no unreported actions exist.

Verification that you are not listed on the OIG List of Excluded Individuals or the SAM.gov exclusion database.

Check these yourself before applying. Being on either list is an automatic denial.

Maintain a tracking spreadsheet with submission date, payer contact, follow-up dates, and current status for each application.

Contact each payer's credentialing department biweekly for status updates. Document the representative's name and action items.

Ask for a specific timeline and the name of the analyst assigned to your file.

Respond to any requests for additional information within 48 hours. Delays here reset the processing clock.

Obtain written confirmation of your credentialing effective date from each payer. Do not bill before this date.

Log in to CAQH every 120 days and re-attest your information is current. Set calendar reminders — expired attestations block re-credentialing.

CAQH sends email reminders, but don't rely on them. Put it on your compliance calendar.

Monitor expiration dates for state license, DEA, and board certification. Upload renewals to CAQH immediately upon receipt.

Ensure continuous malpractice coverage with no gaps. Upload new COI to CAQH and notify payers of any policy changes.

Maintain required continuing education credits for license renewal and board certification maintenance. Keep certificates organized.

Notify all payers within 30 days of any changes: new address, phone, added/removed providers, ownership changes.

Complete re-credentialing applications when received from each payer. Typically due 90 days before your cycle expiration.

Run yourself and all staff through the OIG exclusion list monthly or at minimum annually. Document each check.