Whether you’re a solo practitioner, launching a new multi-specialty clinic, or scaling a busy practice—credentialing is doable, repeatable, and often faster than you think. If you’re unsure about anything, call the payer’s provider services. They have dedicated staff to help you get it right.
Compliance: This guide is educational—not legal, coding, or contracting advice. Always follow federal/state rules and each payer’s requirements.
Apply for your individual NPI (Type 1) and, if you’ll bill as a clinic or group, your organization NPI (Type 2) in NPPES. CMS explains the Type 1 vs Type 2 distinction here: NPI fact sheet (PDF).
Create or update your CAQH ProView profile. Upload licenses, malpractice, education, and work history, then attest so plans can view your data. Most plans expect re-attestation on a regular cadence (commonly every 120 days). See the official CAQH Provider User Guide (PDF) for what’s required.
Set up a CMS Identity & Access account for each provider and, if staff will submit on a provider’s behalf, add surrogate access. Then complete enrollment in PECOS using the appropriate CMS-855 application(s). For help, contact your Medicare Administrative Contractor (MAC): Enrollment assistance or the nationwide MAC list (PDF).
Start with State Medicaid enrollment, then add Medicaid Managed Care Organizations (MCOs) your patients use. Requirements and portals vary—use Medicaid.gov to jump to your state’s official site: Medicaid state overviews.
Call the plan’s provider services/credentialing line (usually on the back of the member’s card) or use the plan’s portal to request participation. Your opening email can be as simple as: “We’re a new PT/OT/SLP clinic seeking network participation. Our group NPI is [Type 2], EIN [####], and clinicians’ NPIs and CAQH IDs are attached.” Keep your CAQH profile attested and ready; most plans pull directly from CAQH to verify details.
Maintain a simple grid with payer contacts, application dates, reference numbers, and effective dates. For new hires, plans often accept a short form or portal submission to add a rendering provider to your existing group contract—share the clinician’s NPI, license, CAQH ID, and start date. For Medicare/Medicaid, affiliate the provider appropriately (e.g., 855R in PECOS) before billing under the group.
Credentialing timelines vary by payer and state. A straightforward commercial plan can complete in weeks; Medicare and some Medicaid agencies can take longer depending on volume and background checks. The best accelerator is clean paperwork and quick responses—plus calling provider services if anything stalls.
Tip: While you wait for network approvals, set up eligibility checks and clean billing workflows so you can move quickly once effective dates arrive.
Credentialing verifies your clinicians and clinic; contracting establishes rates and effective dates. Some plans run these in parallel; others credential first, then send a contract.
Yes—each clinician has a Type 1 NPI; your organization has a Type 2 NPI if you bill as a group. CMS explains the difference here: NPI fact sheet (PDF).
Generally every 120 days (some states use 180). If you miss it, plans may pause processing until your profile shows “current.” Reference: CAQH ProView Provider Guide.
Your regional Medicare Administrative Contractor (MAC) offers phone support and tutorials. Start with CMS’s enrollment contacts page, then log into PECOS. Enrollment assistance & contacts · PECOS login.
Use Medicaid.gov’s state overview list to jump to your state’s official site and provider enrollment page: Find your state.
We’re happy to walk the process with you—NPIs, CAQH, Medicare PECOS, Medicaid, and commercial outreach. The goal is simple: start seeing patients and get paid promptly.
