Insurance Credentialing Checklist: Everything You Need to Get Started

Getting credentialed with insurance companies is one of the most important steps in building a successful behavioral health practice. It is also one of the most complex and detail-oriented. Missing a single document or skipping a step can delay your credentialing by weeks or months, which directly translates to lost revenue. This checklist gives you a clear, actionable roadmap for the entire credentialing process, from preparation through approval and ongoing maintenance.

Phase 1: Gather Your Documentation

Before you submit a single application, gather all the documents you will need. Having everything ready before you start prevents delays caused by scrambling for paperwork mid-process.

Professional Licenses

• Active state license for each state where you plan to practice (e.g., LCSW, LPC, LMFT, PsyD, PhD, MD, PMHNP)
• Clear, legible copy or PDF of each license (not expired)
• Verification that your license is active and in good standing on the state licensing board website
• If you hold a temporary or provisional license, verify which payers accept it for credentialing

National Provider Identifier (NPI)

• Type 1 NPI (individual provider) -- apply at nppes.cms.hhs.gov if you do not have one
• Type 2 NPI (organizational) -- if you are billing under a group practice
• NPI confirmation letter or screenshot of your NPPES record
• Verify that all information in NPPES matches your license, CAQH profile, and payer applications exactly

Tax Identification

• Social Security Number (SSN) if billing as a sole proprietor
• Employer Identification Number (EIN) if billing under a business entity -- apply at irs.gov if needed
• Completed W-9 form with your current business name and Tax ID
• IRS determination letter for your EIN (CP 575 notice)

Education and Training Documents

• Diploma from your degree-granting institution
• Official transcripts (some payers require these; have sealed copies available)
• Certificates of completion for internships, residencies, or fellowships
• Board certification documents (if applicable)
• Continuing education certificates for any specialized training (EMDR, DBT, etc.)

Malpractice Insurance

• Current certificate of liability insurance showing coverage amounts and expiration date
• Minimum coverage typically required: $1 million per occurrence, $3 million aggregate
• Name on the policy must match your legal name on your license
• If you are part of a group, verify whether the policy covers you individually or under the group
• History of all malpractice claims or settlements (past five years minimum)

DEA Registration (If Applicable)

• Current DEA certificate for each state where you prescribe
• DEA number must be active and linked to your current practice address
• Only required for prescribers (psychiatrists, nurse practitioners)

Professional References

• Three professional peer references who can attest to your clinical competence
• References should be licensed healthcare professionals who have worked with you clinically
• Collect their full names, credentials, phone numbers, and email addresses
• Notify your references in advance that they may be contacted by payers

Practice Information

• Practice legal name and doing-business-as (DBA) name
• Practice address(es) for each location where you see patients
• Practice phone number and fax number
• Office hours and days of operation
• ADA accessibility status
• Languages spoken at the practice
• Whether you are accepting new patients
• Telehealth capabilities and the states you serve via telehealth

Work History

• Complete work history for at least the past five years with no gaps
• For each position: employer name, address, dates of employment, and role
• Written explanations for any gaps longer than 30 days (e.g., parental leave, education, relocation)

Phase 2: Set Up Your CAQH ProView Profile

CAQH ProView is the universal credentialing database used by virtually every commercial payer and most Medicaid managed care organizations. Setting this up before submitting payer applications saves significant time.

Registration

1. Go to proview.caqh.org and register (or claim your existing profile if a payer pre-registered you)
2. Enter your NPI, SSN or Tax ID, date of birth, and license number for identity verification
3. Record your CAQH provider ID number -- you will need it for every payer application

Profile Completion

1. Complete every section of the profile: personal information, professional IDs, education, training, work history, practice locations, malpractice insurance, and references
2. Upload clear, high-resolution copies of all supporting documents (licenses, DEA, malpractice certificate, diplomas)
3. Verify that your name, address, and NPI match across CAQH, NPPES, and your state licensing board record
4. Review the completion percentage -- aim for 100% in every section

Payer Authorization

1. Navigate to the Plan Authorization section
2. Search for and authorize every payer you plan to credential with
3. Common payers to authorize: Aetna, Anthem/BCBS, Cigna, UnitedHealthcare, Humana, Magellan, Carelon, state Medicaid MCOs
4. Authorize broadly -- you can always remove authorization later, but missing authorization delays credentialing

Initial Attestation

1. Review every section of your completed profile one final time
2. Click "Attest" to certify that all information is accurate
3. Note the attestation date -- you will need to re-attest every 120 days
4. Set a calendar reminder for 90 days from now to begin your first re-attestation

Phase 3: Medicare and Medicaid Enrollment

If you plan to accept Medicare or Medicaid, enroll with these government programs before or concurrently with commercial payer applications.

Medicare Enrollment (PECOS)

1. Create an account at pecos.cms.hhs.gov
2. Complete the CMS-855I application (individual) or CMS-855B (group)
3. Upload all required supporting documents
4. Submit the application electronically
5. Medicare enrollment typically takes 60 to 90 days
6. Once approved, you will receive a Medicare PTAN (Provider Transaction Access Number)
7. Note: Not all behavioral health provider types are eligible for Medicare enrollment. Licensed clinical social workers, psychologists, psychiatrists, and psychiatric nurse practitioners generally qualify. LPCs and LMFTs became eligible for Medicare as of January 2024.

Medicaid Enrollment

1. Identify your state Medicaid agency website and online enrollment portal
2. Complete the state-specific Medicaid enrollment application
3. If your state uses Medicaid managed care, you will also need to enroll with each MCO separately
4. Medicaid enrollment timelines vary widely by state, from 30 days to six months
5. Some states require a site visit before approving enrollment

Phase 4: Commercial Payer Applications

With your CAQH profile complete and government enrollments submitted, begin applying to commercial insurance payers. Prioritize based on the insurance your potential client population is most likely to carry.

Determine Which Payers to Apply To

• Research which insurance plans are most common in your geographic area
• Check whether each payer is accepting new behavioral health providers in your area (network adequacy)
• Decide whether to start with major national payers (Aetna, Cigna, UnitedHealthcare, BCBS, Humana) or state-specific plans
• Consider behavioral health carve-out payers (Carelon, Magellan, Optum Behavioral Health) separately from the medical plans

Submit Applications

1. Contact each payer's provider enrollment or provider relations department
2. Request a credentialing application or identify their online application portal
3. Complete the application, providing your CAQH provider ID when asked
4. Submit any supplemental forms the payer requires beyond CAQH data
5. Retain confirmation of submission (email confirmation, reference number, or screenshot)
6. Note the date of submission for each payer -- this is important for tracking timelines

Common Payer-Specific Notes

• Aetna: Apply through the Availity portal. Typically 60-90 day turnaround.
• Cigna: Application available through Cigna's provider website. They may have a network lock in some areas.
• UnitedHealthcare/Optum: Apply through the UHC provider portal. Behavioral health is often managed through Optum.
• BlueCross BlueShield: Each state has an independent BCBS plan with its own application process. Check your local BCBS.
• Humana: Apply through the Humana provider portal. Availability varies by region.
• Medicaid MCOs: Each MCO has its own application separate from state Medicaid enrollment.

Phase 5: Track and Follow Up

Credentialing applications do not process themselves. Proactive follow-up is essential to avoid your application sitting in a queue.

Create a Tracking System

• Build a spreadsheet or use credentialing software to track each application
• For each payer, record: payer name, date applied, contact person, phone number, application reference number, current status, next follow-up date, and notes
• Update the tracker after every interaction with a payer

Follow-Up Schedule

• First follow-up: Two weeks after submission to confirm the application was received and is complete
• Subsequent follow-ups: Every two to three weeks until approval
• Be polite but persistent. Credentialing departments handle thousands of applications and yours can easily get delayed without follow-up
• Ask specific questions: "Has primary source verification been completed?" "Is the file with the credentialing committee?" "Is there anything outstanding that you need from me?"
• Keep a log of every call including the date, time, representative name, and what was discussed

Respond to Requests Promptly

• If a payer requests additional documents or information, respond within 48 hours
• Delayed responses to payer requests are one of the most common causes of credentialing delays
• If you receive a deficiency notice, address every item listed before resubmitting

Phase 6: Post-Approval Setup

Once credentialed and enrolled, there are several steps to complete before you start seeing a payer's members.

Verify Your Information

• Confirm that your name, credentials, practice address, phone number, and specialty are listed correctly in the payer's online provider directory
• If any information is incorrect, submit a correction request immediately
• Verify that your effective date with the payer is documented -- this is the earliest date you can bill

Set Up Claims Submission

• Register with a clearinghouse (e.g., Availity, Office Ally, Trizetto) for electronic claims submission
• Enroll each payer for electronic claims through the clearinghouse
• Set up electronic remittance advice (ERA) so you receive explanation of benefits electronically
• Set up electronic funds transfer (EFT) for direct deposit of reimbursements

Update Your Website and Marketing

• List the insurance plans you now accept on your website
• Update your Psychology Today profile, therapist directory listings, and Google Business Profile
• Inform your referral sources that you are now in-network with specific payers

Phase 7: Ongoing Maintenance

Credentialing is not a one-time project. Ongoing maintenance ensures you remain in good standing with every payer.

Recurring Tasks

• Re-attest your CAQH ProView profile every 120 days
• Update CAQH immediately when any information changes (new address, new license, new malpractice policy)
• Renew state licenses before expiration and upload new licenses to CAQH and notify payers
• Respond to recredentialing applications from payers every two to three years
• Keep your NPPES record current
• Monitor your listing in each payer's provider directory for accuracy

Timeline Expectations

Here is a realistic timeline for the full credentialing process:

• Document gathering and CAQH setup: 1 to 2 weeks
• Payer application submission: 1 to 2 weeks (submitting to multiple payers)
• Credentialing processing time: 60 to 120 days per payer (some take longer)
• Total time from start to first payer approval: Typically 3 to 4 months
• Total time to be in-network with all target payers: 4 to 6 months

Getting Help with Your Credentialing Checklist

This checklist covers the essential steps, but executing each one correctly and efficiently is where many behavioral health providers get stuck. Between gathering documents, navigating different payer portals, following up on applications, and maintaining your CAQH profile, the administrative workload can be overwhelming.

Behavioral Health Contracting helps behavioral health providers work through every item on this checklist. From initial document gathering and CAQH setup through payer applications, follow-up, and ongoing maintenance, we manage the process so you can focus on building your clinical practice. If you want to get credentialed as quickly and painlessly as possible, reach out for a free consultation. We will review your current status, identify what needs to be done, and create a plan to get you accepting insurance as soon as possible.