Use this checklist to see how prepared your practice is for a successful credentialing process. Readiness matters because delays can lead to lost revenue, denials and compliance issues. The more items you check, the smoother your credentialing journey will be.
📁 1. Organizational Information for Credentialing
☐ Legal business name matches IRS records
☐ Tax ID Number (TIN) and NPI are active and valid
☐ Business entity is properly registered (LLC, PC, etc.)
☐ Up-to-date malpractice insurance with correct policy details
👤 2. Provider Documentation Needed for Credentialing
☐ Valid professional license(s) in all practicing states
☐ Board certifications and continuing education records
☐ DEA certificate (if prescribing medications)
☐ State-controlled substance registration (if applicable)
☐ Up-to-date CV (chronological, no unexplained gaps)
📋 3. Practice Operations
☐ Office address and phone number are current
☐ W-9 form is completed and signed
☐ Business hours and services offered clearly documented
☐ Staff roles and titles are defined
💻 4. CAQH, NPPES & Online Credentialing Profiles
☐ CAQH profile is completed and attested
☐ All documents uploaded to CAQH are current
☐ NPPES profile is accurate (NPI registry)
☐ PECOS enrollment is active (for Medicare providers)
💰 5. Insurance Payer-Specific Credentialing Readiness
☐ Target list of insurance payers is created
☐ Knowledge of each payer’s requirements and timelines
☐ Ready to submit applications individually or via delegated credentialing
📦 6. Internal Credentialing Process
☐ Dedicated staff or team for credentialing
☐ Timeline expectations set (90–150 days on average)
☐ Process in place to follow up with payers regularly
☐ Method to track application statuses
📉 7. Risk Factors That Delay Credentialing
☐ No past license suspensions or malpractice issues
☐ Gaps in work history are clearly explained
☐ No disciplinary actions by state boards
🧭 Scoring Your Credentialing Readiness
- ✅ 24–28 checks: Credentialing-Ready – You’re in great shape to start or streamline your credentialing.
- ⚠️ 15–23 checks: Partial Readiness – You’re close, but gaps may slow you down or lead to denials.
- ❌ 0–14 checks: At-Risk – Credentialing delays, rejections, or payer issues are likely without support.
👉 Not Fully Ready? We’ve Got You.
CredEdge handles credentialing from start to finish. Document collection, application submission, payer follow-ups, and compliance monitoring.
🎯 Get Expert Help with Credentialing
