How it works
What actually happens, and how long it takes
Credentialing has more waiting in it than working. The difference a good process makes is in how little of that waiting is avoidable.
Week 1
Intake
We collect everything once: licences, DEA, board certification, education and training, full work history, malpractice coverage and claims history, W-9 and practice details. Doing this properly at the start is what prevents applications coming back.
Week 1–2
CAQH built or brought current
Profile completed, documents uploaded, attestation done, and payer authorizations set so each payer can actually pull the data.
Week 2–3
Applications filed
Each payer gets its own correctly formatted submission. Medicare and Medicaid go in parallel through their own systems.
Week 3 onward
Follow-up and escalation
Scheduled contact with every payer, dated notes on each conversation, and escalation when a file goes quiet. This is the part practices don't have time for, and it's where most of the delay hides.
Typically 90–180 days
Approval
Commercial payers commonly take three to six months from a clean application. Medicare is often faster. Some states' Medicaid programs are slower.
At approval
Confirmed and billable
We verify the provider is loaded in the payer's system with the correct effective date and group linkage — and ask for retroactive dates where the payer permits.
Ongoing
Maintenance
Quarterly CAQH re-attestation, expirables tracked, re-credentialing filed ahead of each deadline.
A note on timelines. Anyone promising a fixed turnaround for commercial credentialing is guessing — the payer controls the clock. What we can control is that your application is complete on the first pass and that nobody forgets to chase it.