How to Get Credentialed with Insurance Companies

(Updated Sept. 2025)

A Step-by-Step Guide for Healthcare Providers

Knowing how to get credentialed with insurance companies is an essential step for any healthcare provider who wants to join insurance networks, serve a broader patient base, and get reimbursed for services. But the insurance credentialing process can be complex, time-consuming, and confusing—especially if you’re just starting out or expanding your practice.

This guide explains what credentialing is, how to navigate it successfully, and what you can do to avoid delays and costly mistakes. 

Quick note: Insurers often use ‘credentialing’ loosely, but payer enrollment/contracting is the administrative step that actually gets you in-network; for a clear definition of each (including how hospitals credential and how sanctions/malpractice history factor in), see Credentialing vs. Enrollment: What’s the Difference?

What Is Credentialing in Medical Billing?

Credentialing is the process insurance companies use to verify a healthcare provider’s qualifications. It confirms that you have the proper licensing, board certification, malpractice insurance, and experience to offer care under a specific insurance plan.

Credentialing is required whether you’re applying to join Medicare and Medicaid, commercial networks like Blue Cross Blue Shield, or any private insurance plan. Once approved, you become an in-network provider and can bill insurance directly for covered services.

Why Does Getting Credentialed with Insurance Matter?

Being in-network makes your services accessible to more patients and ensures timely reimbursement. Without it, you may:

• Lose out on referrals or incoming patients
• Get paid slower (or not at all)
• Appear less credible to patients seeking covered care
• Subject your claims and patients to higher out of pocket requirements

Credentialing protects patients and providers alike by confirming that only qualified professionals participate in insurance networks.

Key Steps to Get Credentialed with Insurance Companies

1. Identify Which Insurance Plans You Want to Join

Start by evaluating the plans most relevant to your specialty, location, and patient population. Think about:

• Medicare and Medicaid if you serve older adults or underserved communities
  
• Blue Cross Blue Shield, Aetna, Cigna, and UnitedHealthcare if you’re in private practice
  
• Regional or local plans that align with your practice goals
  

Being selective helps avoid wasted time applying to networks that don’t align with your practice.

2. Gather Required Credentialing Information

Most insurance companies will require a wide range of documents and data. Having these ready upfront can help avoid delays:

• State medical license and DEA registration
  
• Board certification (if applicable)
  
• Malpractice liability insurance (proof and policy limits)
  
• National Provider Identifier (NPI) number
  
• Tax ID and W-9 form
  
• Practice address, hours, and contact info
  
• Educational history, residencies, and work experience
  
• Hospital affiliations and professional references
  

This is one of the most time-consuming parts of the credentialing application process—accuracy matters.

3. Complete Your CAQH Profile

The Council for Affordable Quality Healthcare (CAQH) offers a universal credentialing system that many major insurance companies use.

• Create an account and complete your online profile at caqh.org
  
• Submit all requested documentation
  
• Grant access to insurers you’re applying to
  

Maintaining an up-to-date CAQH profile is essential for successful credentialing with multiple insurance companies.

4. Submit the Credentialing Application to Each Insurance Company

While CAQH simplifies the data entry process, you still need to apply to each insurer separately. This step is often referred to as the contracting phase, where you request to join the insurer’s network and accept their reimbursement rates.

This step is effectively your payer enrollment/contracting phase—the piece that establishes network participation and generates effective dates (details in Credentialing vs. Enrollment: What’s the Difference?).

Be prepared to:

• Fill out insurer-specific forms
  
• Submit your CAQH ID and additional information
  
• Review and negotiate contract terms if needed
  

5. Follow Up and Avoid Delays

Credentialing timelines vary, but most take 60–120 days or more. To avoid delays:

• Proactively follow up with insurance reps
  
• Track all submitted forms and correspondence
  
• Respond quickly to requests for additional documentation
  

Even one missing signature or outdated document can slow down the process.

6. Receive Approval and Join the Network

Once approved, you’ll receive confirmation and can begin seeing patients under the plan. You’ll also be expected to:

• Comply with administrative rules, like timely claim filing
  
• Undergo re-credentialing every 2–3 years
  
• Stay current with licensing and liability insurance
  

Credentialing isn’t a one-time task—it requires ongoing attention.

What Do Credentialing Companies Do for Providers?

Credentialing companies help providers navigate the complex and time-consuming credentialing process. A trusted partner can:

• Ensure paperwork is filled out correctly
  
• Handle communication with insurers
  
• Track submissions and deadlines
  
• Monitor re-credentialing requirements
  

This not only saves time but can reduce errors, avoid revenue loss, and improve your chances of faster approval.

Common Challenges in the Insurance Credentialing Process

• Missing or incorrect documentation
  
• Delays from insurers during high-volume times
  
• Confusion about insurance panels and reimbursement structures
  
• Failure to maintain credentials or CAQH updates
  

Working with experienced credentialing professionals can help you stay compliant and avoid disruptions in care or billing.

FAQs: Credentialing with Insurance Companies

1. How long does it take to get credentialed with insurance companies?
   Most applications take 60–120 days. Start early to avoid gaps in reimbursement.
2. Can I see patients while waiting to be credentialed?
   Yes, but you may not get paid until your credentialing is approved. Some insurers allow retroactive billing—others do not.
3. Do I need to update my credentialing information regularly?
   Yes. Licenses, liability insurance, and CAQH profiles must stay current. Failure to update can result in delays or termination.
4. Is credentialing the same as contracting?
   Credentialing verifies qualifications; contracting finalizes your participation in the network, including reimbursement rates. For precise definitions and how credentialing differs from payer enrollment, see Credentialing vs. Enrollment: What’s the Difference?
5. What is the difference between being in-network and out-of-network?
   In-network providers are approved by the insurer and accept negotiated rates. Out-of-network providers may be reimbursed at lower rates or not at all.

Get Credentialed the Right Way with MBA Medical

At MBA Medical, we help healthcare providers navigate every step of the credentialing process with accuracy, efficiency, and a commitment to getting it right the first time. From preparing credentialing information to submitting applications and following up with insurers, we handle the details so you can stay focused on patient care.

Whether you’re a solo practitioner, part of a growing group, or launching a new clinic, our credentialing experts are here to support you.

Ready to join more insurance networks and grow your patient base? Contact MBA Medical today to learn how we can help with credentialing and other essential practice management services.