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The Complete Provider Credentialing Checklist

50 steps from NPI to in-network effective date, plus CAQH prep pack, payer application templates, and enrollment tracking. Built from 340+ successful credentialing projects.

What's in the Checklist

Phase 1, Pre-Application (Days 1-14)

  1. Obtain or verify Type 1 NPI (individual provider)
  2. Obtain or verify Type 2 NPI (group/entity)
  3. Register Tax ID (EIN) with IRS and confirm match with NPI
  4. Create or update CAQH ProView profile (10-digit CAQH ID)
  5. Upload current state medical license, DEA, and CDS to CAQH
  6. Upload malpractice insurance face sheet (minimum $1M/$3M)
  7. Upload board certification, residency, and education history
  8. Attest CAQH profile, re-attest every 120 days
  9. Step 9. Draft payer cover letter with effective date request
  10. Step 10. Identify payer-specific application forms (see payer matrix)
  11. ...42 more steps through enrollment, contracting, and go-live

Payer Timelines at a Glance

Payer Typical Turnaround CAQH Required Retro Effective Date?
Aetna60-90 daysYesUsually, request in cover letter
UnitedHealthcare90-120 daysYesSometimes, varies by state/line
BCBS (by state)60-150 daysYesVaries by Blue plan
Cigna60-90 daysYesRarely, app date usually wins
Humana45-90 daysYesYes, up to app received date
Medicare (CMS-855I)60-90 days (PECOS)NoYes, up to 30 days retro
Medicaid (state-specific)30-120 daysVariesVaries by state

Get the Full Checklist + CAQH Prep Documents

You'll receive the PDF + editable tracking spreadsheet within 5 minutes.

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. Talk to our credentialing team.