Provider credentialing is how an insurance company checks that you are who you say you are, and that you are qualified to do the work, before it lets you join its network. It is a verification step, and nothing about it is meant to be personal. It simply has to be completed before you can be paid as an in-network provider.
What gets checked
Insurers typically verify your state license, your education and training, your work history, your malpractice insurance, and your identity. They may also ask for professional references and check for any past disciplinary actions.
Who needs it
Anyone who wants to be paid in-network by an insurer: therapists and counselors, physicians, nurse practitioners, physician assistants, and group practices adding new clinicians. If you only take clients who pay out of pocket, you may not need it.
How it works, step by step
- You gather your documents: NPI number, license, malpractice certificate, CV, references and tax ID.
- You complete your CAQH profile, which many insurers use as their source of information. Learn more in our guide to CAQH attestation.
- You apply to each insurer and authorize it to view your profile.
- The insurer verifies everything, which is the credentialing itself.
- If you are approved, you move to contracting and enrollment, and you get an effective date.
Credentialing is not the same as enrollment
People use the two words as if they were one thing. They are two steps, and your billing start date depends on the second one. We explain the difference in credentialing vs. payer enrollment.
How long it takes
A commonly quoted figure is about 90 to 120 days, and it can be longer if there are errors or missing documents. You will usually be asked to re-confirm your details every couple of years, so credentialing is not a one-time job.
If you want a rough range for your own situation, try our free timeline estimator. If you would rather not do it yourself, see how we help or get a quote.
Quick answers
What is provider credentialing in simple terms?
It is the process where an insurance company verifies your license, training, work history and insurance before accepting you into its network.
Who needs to be credentialed?
Any provider who wants to be paid in-network by an insurance company, including therapists, physicians, nurse practitioners and group practices.
How long does credentialing take?
A commonly quoted figure is about 90 to 120 days, depending on the insurer and how complete your application is.
This article is general information, not legal or financial advice. Rules and timelines vary by insurer and state, so check directly with each insurer or with CMS. Sources: BetterHelp: A Therapist's Guide to Insurance Credentialing, Grow Therapy: CAQH setup and maintenance.
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