What are the steps to credential a physician?
To credential a physician: (1) gather the provider’s documents (license, DEA, education, board certification, work history, malpractice coverage); (2) create and complete a CAQH ProView profile and keep it attested; (3) submit applications to each payer (commercial, Medicare via PECOS, Medicaid); (4) complete primary source verification of credentials; (5) respond promptly to payer follow-ups; and (6) track approval and link the provider to the billing group for enrollment. The process generally takes 60–120 days per payer.
Credentialing is the unglamorous process that stands between a qualified physician and getting paid. Done well, it’s invisible. Done poorly, it delays revenue for months. Here’s how it actually works.
What credentialing is (and isn’t)
Credentialing is the verification of a provider’s qualifications — education, training, licensure, board certification, and history. It’s distinct from enrollment, which puts the credentialed provider into a payer’s network so claims are paid. You need both, and they’re usually pursued together.
The credentialing process, step by step
1. Gather documentation
Collect the provider’s license, DEA registration, education and training history, board certifications, malpractice coverage (including history), NPIs, and a current CV. Any unexplained gap in work history will trigger questions — address them up front.
2. Build and attest the CAQH profile
Create or update the provider’s CAQH ProView profile, upload supporting documents, and complete attestation. Most commercial payers pull from CAQH, so an incomplete profile stalls everything downstream.
3. Submit payer applications
Apply to each payer: commercial plans, Medicare (via PECOS), and Medicaid (in Michigan, CHAMPS). Each has its own forms and quirks.
4. Primary source verification
The payer independently verifies credentials directly with the issuing sources — licensing boards, schools, certification bodies. Nothing is taken at face value.
5. Respond fast to follow-ups
Payers frequently request clarifications. Every day a request sits unanswered is a day added to the timeline. Speed here is worth real money.
6. Approval and enrollment linkage
Once approved, the provider is linked to your billing group and tax ID so claims pay correctly. Now — and only now — can you bill for that provider.
How long does it take?
Plan for 60–120 days per payer. The single biggest variable you control is application quality: complete, consistent, well-documented submissions move quickly; sloppy ones bounce between desks for months.
How to avoid the costly delays
- Start early — especially for new practices and new hires.
- Keep CAQH current and attested year-round.
- Track every expirable — licenses, DEA, board certs, and re-credentialing dates.
- Follow up relentlessly — applications don’t move themselves.
This is exactly the work MMSM’s credentialing service takes off your plate. We submit clean applications, chase every follow-up, and connect credentialing straight through to enrollment and billing — so your providers start earning sooner.
Need providers credentialed without the headache? Get started or call (517) 485-0001.
