Credentialing Checklist for New Practices

Mukesh MakwanaFounder & CEO · Hands-on medical billing & RCM across 11 specialties · Reviewed October 1, 2026

This is the checklist we work through when a new practice asks us to get it in network. Tick off each box in order: the practice's own identity first, then each clinician's documents, then Medicare, Medicaid and commercial plans, then the steps after approval that make sure claims actually pay. It is written with therapists, psychologists and psychiatrists in mind, and it works for any specialty.

The practice's identity

Payers check that the business on the application matches the business on the claim. Get these settled before a single application goes out, because changing them later means changing every enrollment.

• Legal entity formed and an EIN issued by the IRS. Every payer pays the entity on its tax ID, so the name on the EIN letter is the name you use everywhere.
• Organizational (Type 2) NPI from NPPES, with the legal name, practice address and taxonomy code exactly as they will appear on applications.
• Taxonomy code chosen on purpose. The NUCC taxonomy list has separate codes for counselors, social workers, marriage and family therapists, psychologists and psychiatrists. A group code that does not match the clinicians' codes causes avoidable questions.
• Service location you can document, with a lease or other proof. Applications ask where care is delivered, including telehealth-only arrangements.
• Business bank account in the entity's name, plus a voided check or bank letter for electronic funds transfer forms.
• Signed W-9 and a one-page practice fact sheet (legal name, EIN, Type 2 NPI, addresses, phone, hours, owners) so every form is filled in from one source.

Each clinician's file

Gather one folder per clinician and check every date in it. An expired malpractice certificate or an unattested CAQH profile is enough to send an application back to the start of the queue.

• Individual (Type 1) NPI from NPPES, with the same spelling of the name as the license.
• Active, unrestricted state license for every state where patients are located during sessions, including telehealth patients.
• DEA registration for prescribers, through the DEA Diversion Control Division, for each state where they prescribe controlled substances.
• Malpractice certificate of insurance naming the clinician, with current dates and limits shown.
• CV with month and year for every job and training program, and a written explanation for each gap.
• Diplomas, training certificates and board certification where the clinician holds one.
• CAQH ProView profile complete, documents uploaded, attested, and each payer authorized to view it. CAQH asks for re-attestation every 120 days (every 180 days in Illinois), per its quick reference guide.
• Supervision or collaboration agreements where your state or a plan requires them for a clinician's license type.

Medicare

• Group enrollment for the practice and individual enrollment for each clinician, filed online in PECOS.
• Reassignment of each clinician's Medicare benefits to the group, so payment goes to the practice and not to the individual.
• Check eligibility by license type. Since January 2024, marriage and family therapists and mental health counselors can enroll and bill Medicare directly (CMS).
• Electronic funds transfer set up with the CMS-588 form or in PECOS.
• Know the effective date rule. Medicare sets the effective date from the later of the filing date of an application it approves and the date you first furnished services at the new location (42 CFR 424.520(d)). Billing for services before that date is allowed only for up to 30 days, and only when circumstances prevented enrolling in advance (42 CFR 424.521).

State Medicaid and its managed care plans

• State Medicaid enrollment through your state agency's provider enrollment portal, for the group and each clinician.
• Medicaid managed care plans next. Federal rules require states to screen and enroll every network provider of their managed care plans (42 CFR 438.602(b)), so plan contracts usually wait on state enrollment.
• A list of the managed care plans in your area, taken from the state Medicaid website, with each plan's credentialing contact.

Commercial plans

Start with the plans your patients actually carry. A therapist leaving a group practice can usually ask existing patients which plan is on their card; that list is a better guide than any ranking of insurers.

• Ask whether the panel is open for your specialty and county before you spend time on an application.
• Submit each plan's application and point it to the CAQH profile; keep the submission date and reference number.
• Read the contract before signing: fee schedule, timely filing limit, termination terms, and which locations and clinicians it covers.
• Get the effective date in writing for each clinician at each plan. Credentialing approval is not the same as a signed contract.

After approval: make sure claims pay

• Load every payer into the practice management system with the right group and individual numbers.
• Set up electronic remittance and funds transfer with each payer.
• Send a first claim and watch it pay before booking a full schedule under that plan.
• Put every renewal on a calendar: CAQH re-attestation, licenses, DEA, malpractice, Medicare revalidation every 5 years (42 CFR 424.515) and each plan's re-credentialing cycle.

Common reasons applications stall

• Names and addresses that do not match across NPPES, CAQH, the license and the application, even by one abbreviation.
• CAQH not attested, or the payer not authorized to view the profile, so the plan cannot start its review.
• Unexplained gaps in work history.
• Missing or expired documents: malpractice certificate, license, DEA registration.
• Clinicians never linked to the group, so claims go to the wrong tax ID or deny.
• Applying to a closed panel without asking first.
• No follow-up. Applications that nobody checks on tend to sit. Note each submission date and call back on a set schedule.

Notes for behavioral health practices

Pre-licensed and associate-level clinicians are where most behavioral health credentialing problems start. Plans differ on whether they credential associates at all, and Medicare enrolls only licensed clinicians, so ask each plan for its written policy before scheduling patients with an associate. Telehealth does not remove licensing rules: the clinician needs a license where the patient is located. For the step-by-step version of this list, see how to get credentialed with insurance companies; for therapist-specific detail, see credentialing services for therapists.

Want us to work the checklist for you?

Sterling Global Solution LLC runs this list with new practices: we collect and check each document once, build and attest CAQH, file the Medicare and Medicaid enrollments, submit each commercial application and follow up until the effective dates are confirmed in writing. New billing clients get credentialing with 3 insurance payers at no cost through our free credentialing offer. If you are still deciding which plans to join, our guide to how long insurance credentialing takes explains what each payer publishes about processing times.

Frequently asked questions

Sources

Code of Federal Regulations, 42 CFR 424.520(d) (Medicare effective date), 42 CFR 424.521 (retrospective billing) and 42 CFR 424.515 (revalidation).
Code of Federal Regulations, 42 CFR 438.602(b): states screen and enroll Medicaid managed care network providers.
CAQH, CAQH ProView Quick Reference Guide for Providers.
Centers for Medicare & Medicaid Services: NPPES, PECOS, CMS-588, marriage and family therapists and mental health counselors and Medicare Program Integrity Manual, chapter 10.
IRS: get an employer identification number; NUCC health care provider taxonomy; DEA Diversion Control Division registration.

Medicaid and commercial requirements vary by state and plan. How we verify this guidance.

Related reading

• How to get credentialed with insurance companies. The same steps explained in detail.
• Credentialing services for therapists. What changes for counselors, social workers and MFTs.
• Medicare credentialing services. PECOS, reassignment and revalidation.
• How long does insurance credentialing take?. What each payer publishes about processing times.
• Free credentialing for new billing clients. Credentialing with 3 insurance payers at no cost.