In many cases, the problem is not the provider’s qualifications but missing, outdated, or incorrect information.

Missing Documents

Insurance companies may require documents such as:

• State professional license
• NPI
• Malpractice insurance
• DEA registration, when applicable
• Board certification, when applicable
• Education and training information
• Work history
• W-9
• CAQH information

Incorrect Information

Small differences between the application and supporting documents can create problems.

CAQH

For many providers, CAQH is an important part of the credentialing process. If the provider has not completed the profile, uploaded required documents, authorized the payer, or completed the required attestation, the payer may not be able to complete the process.

Failure to Respond to Payer Requests

Sometimes the payer requests additional information after an application has been submitted. If the provider or credentialing team does not respond within the required timeframe, the application may be delayed, closed, or require additional work.

Avoid Credentialing Delays

Before submitting an application, carefully review all information and documents to help reduce unnecessary delays and prevent avoidable problems.

• All required fields are completed
• Supporting documents are current
• CAQH information is accurate
• The provider’s license and NPI information match
• Practice locations are correct
• Work history is complete
• Payer authorization is completed when required
• All payer requests are addressed promptly