How insurance credentialing works
Credentialing is the check a plan runs on your training, license and history. Contracting is the agreement that sets your rates. You need both before a plan pays you as in network, and they happen in this order: the plan verifies you, a committee approves you, you sign the contract, and the plan loads you into its claims system with an effective date.
Medicare and Medicaid call it enrollment. Medicare runs through PECOS, the online system for the CMS-855 forms. Each state runs its own Medicaid enrollment, and in most states Medicaid patients are actually covered by managed care plans that credential you separately once the state has enrolled you. Commercial plans read your CAQH profile, which is now part of DataSpring, instead of asking for paper applications.
The order that saves the most time
- NPI first. Your NPPES record must show your legal name, the right taxonomy and your practice address. Every plan checks it.
- CAQH second. Upload current documents, attest, and give each plan access before you apply. An unattested profile stops commercial reviews cold.
- Then everything at once. Medicare, Medicaid and the commercial plans can run in parallel. Only Medicaid managed care plans wait for the state Medicaid ID.
Why applications get stuck
- A request for more information that sits unanswered for 30 days. Most plans close the file.
- A signature or attestation more than 120 days old by the time the plan reviews it.
- The name or tax ID on the W-9 does not match IRS records, or the taxonomy on the NPI does not match the license.
- An old version of a form. CMS retired the 855R in 2023; reassigning an individual's payments to a group is now part of the 855I.
- Billing before the plan has loaded you. Approval letters arrive before claims systems are updated.
Questions
How much does insurance credentialing cost?
Credentialing companies usually charge $100 to $300 per plan, and packages often run $1,200 to $5,000. With TrueCycle it is $149 per insurance plan, charged only after the plan approves you, $199 each for Medicare and Medicaid, and $599 per provider for our Starter package (CAQH set-up, Medicare and three insurance plans).
How long does credentialing take?
Medicare usually finishes a complete online application in 15 to 50 days. Commercial plans usually take 60 to 120 days, and Medicaid 45 to 120 days, with some states taking longer. Medicaid managed care plans start after the state enrolls you.
Can I see patients while I wait?
Yes, but plan for how you will be paid. Medicare lets you bill for services up to 30 days before your effective date. Most commercial plans pay nothing in network before the effective date in your contract.
Do I need CAQH for Medicare?
No. Medicare uses PECOS. CAQH is for commercial plans and most Medicaid managed care plans.
Do you guarantee approval?
No one can. A plan can decline when its network is full in your area. We tell you up front when a plan is likely closed, and you only pay our insurance fee when a plan approves you.
What information do you need from me?
Your license, NPI, CV, malpractice certificate and practice details, plus your CAQH and PECOS logins if you have them. Sensitive items such as your SSN are collected through a secure, encrypted link, never by email or web form.
Read the guide: what credentialing costs, plan by plan →
Related: Credentialing timeline calculator · Provider credentialing, step by step · Timely filing calculator
Sources, read November 1, 2026: 42 CFR 424.520(d) and 424.521(a) (Medicare effective date and 30-day retroactive billing); 42 CFR 424.518 and 489.28 (high-risk screening, home health reserve funds); CMS consolidated CMS-855I bulletin (855R retired); Federal Register, December 3, 2025 (CY2026 application fee $750); CGS Medicare, May 2026 (home health and hospice enrollment moratorium); CMS, marriage and family therapists and mental health counselors (enrollment from January 1, 2024); DataSpring Provider Data Portal quick reference (re-attestation every 120 days, 180 in Illinois); UnitedHealthcare credentialing FAQ (October 2026); Aetna, Cigna, Evernorth, Anthem and Carelon join-the-network pages; TriWest and Humana Military provider pages; DHCS Medi-Cal provider enrollment FAQ; AANP state practice environment (May 2026); state Medicaid and Medicare contractor enrollment pages linked in the tool; published pricing from credentialing services. Typical ranges only. Each plan's own notice is what counts. General information, not legal advice.