Get Credentialed With Every Major Insurance — Without the Headache

Medicare credentialing is the process the Centers for Medicare & Medicaid Services (CMS) uses to verify that a healthcare provider (like a doctor, practice, or clinic) is qualified — checking things like licensure, education, training, and professional background — before they are approved to bill Medicare for patient services. Providers must complete this before being able to treat Medicare beneficiaries and receive reimbursement. Medicare quotes a typical processing time of 90–120 days… however, we are usually able to get the approval letters issued in about 50 days. A 30-day retroactive effective date will be issued from the date the application was submitted.Hover to read more

• CMS primary source verification
• ~50 day accelerated processing
• 30-day retroactive effective date

Medicaid credentialing is the state-administered process that verifies a healthcare provider's qualifications—including licensure, education, training, malpractice coverage, and professional background—before they can deliver services to Medicaid beneficiaries and receive reimbursement. Since each state manages its own Medicaid program, requirements and timelines vary; some states use CAQH ProView while others require direct portal submissions through the state Medicaid agency. Providers must obtain a valid NPI number, complete background checks and fingerprinting (in most states), and submit all required documentation through the state's online enrollment system. Processing typically takes 30–90 days depending on documentation completeness, and recredentialing is required every 3–5 years to maintain active participation. We handle enrollment with Medicaid programs in all 50 states, including coordination with Managed Care Organizations (MCOs) that contract with state Medicaid agencies.Hover to read more

• All 50 state Medicaid programs
• MCO network enrollment included
• Background check coordination

Blue Cross Blue Shield credentialing is the verification process BCBS uses to confirm a provider's qualifications—including licensure, education, board certifications, malpractice insurance, and professional history—before granting network participation status. BCBS is a federation of 34 independent, locally operated companies across all 50 states, so credentialing requirements and timelines may vary by region; however, most BCBS affiliates use CAQH ProView to gather and verify provider credentials. Providers must complete the CAQH application, authorize their regional BCBS affiliate to access their profile, and submit any additional documentation required by that specific plan. Processing typically takes 45–120 days depending on provider type and documentation completeness, with recredentialing required every three years. Once credentialed, providers gain access to over 115 million BCBS members nationwide—making it one of the most valuable networks for patient reach and practice growth.Hover to read more

• All 34 regional BCBS affiliates
• CAQH ProView integration
• 115M+ member network access

Aetna's credentialing is how Aetna verifies a health care provider's professional qualifications (like licenses, training, certifications, malpractice coverage) before they can join its network and treat Aetna members. It typically uses the CAQH ProView database for collecting and checking credentials. After you apply and authorize Aetna to access your CAQH data, Aetna reviews everything to make sure you meet their standards. Once credentialed and contracted, you're added to the network and can bill for services. Aetna quotes a 90–120 day application processing timeline.Hover to read more

• CAQH ProView integration
• Primary source verification
• Full contracting support

UnitedHealthcare credentialing is how UHC verifies your professional qualifications (like license, work history, insurance) before you can join its network. You typically start by submitting your information (often through Onboard Pro and/or CAQH) and giving UHC access to your profile. UHC then conducts primary source verification of your credentials and reviews them against standards (NCQA-compliant). Once approved and contracted, you can see and bill UnitedHealthcare members. The process usually takes several weeks (often ~45–90 days) and recredentialing happens about every three years.Hover to read more

• NCQA-compliant process
• Onboard Pro + CAQH submission
• 3-year recredentialing cycle

Cigna's credentialing process verifies that healthcare providers meet established quality, safety, and professional standards before they can join the insurer's network. Providers must submit a signed application with required documentation—such as current state licensure, DEA certification (if applicable), professional liability insurance, education and training history, and work history—and often complete a CAQH ProView profile to streamline data submission. Cigna conducts primary source verification of this information and reviews it through a credentialing committee composed of peer providers and clinical leaders to ensure compliance with Cigna's criteria. Once approved, providers receive notification of their network status and can begin seeing Cigna patients at in-network rates; the initial process typically takes 45–90 days depending on documentation completeness and responsiveness. To maintain active participation, providers must undergo recredentialing about every three years, during which the same core criteria are re-verified and updated.Hover to read more

• Peer-reviewed committee approval
• CAQH ProView submission
• DEA certification coordination

Optum's credentialing process starts after a provider expresses interest and often signs a Participating Provider Agreement. Providers complete and submit a credentialing application—frequently using CAQH ProView or an online portal—along with required documentation such as current state licenses, professional liability coverage, education and training history, and work history. Optum verifies this information with primary sources and may work with third-party partners like Aperture; once verification is complete, a credentialing committee of peer clinicians reviews the application to determine whether the provider meets Optum's network standards. Approved providers receive a welcome letter or executed agreement indicating their effective participation date. The credentialing timeline typically ranges from about 60 to 90 days for complete applications, though it can extend to several months depending on documentation completeness and plan or state requirements. Providers must also undergo recredentialing approximately every three years to maintain network status.Hover to read more

• Aperture third-party verification
• Participating Provider Agreement
• Welcome letter with effective date

Humana's credentialing process requires healthcare providers to submit an application with necessary documentation—such as current state licensure, professional liability insurance, work history, and other qualifications—and often involves using CAQH ProView to streamline data submission. Humana's credentialing team conducts primary source verification of this information and reviews it to confirm a provider meets clinical, regulatory, and quality standards before granting network participation. Once verified and approved by Humana's credentialing committee, providers enter into a participation agreement and can be listed in Humana's provider directory. After initial approval, Humana requires recredentialing at least every three years to reassess licensure status, sanctions, performance information, and other factors to maintain network status. The credentialing timeline typically ranges from about 60 to 90+ days depending on documentation completeness and plan requirements.Hover to read more

• Provider directory listing
• Portal-based status tracking
• Participation agreement support

To join the TRICARE East network, a healthcare provider must first be certified and credentialed through the region's contractor (Humana Military) before they can bill TRICARE for services. Providers typically begin by confirming eligibility and gathering key documentation—such as an active state license, National Provider Identifier (NPI), malpractice insurance proof, Tax ID (EIN), and any required DEA registration—and then submit an application through Humana Military's provider self-service portal, often using a current CAQH ProView profile to support credential verification. The credentialing review includes verifying licensure, education, work history, and other credentials against primary sources; once approved and a contract is fully executed, providers are listed as in-network TRICARE East providers and can begin care under negotiated rates. The process usually takes about 60–90 days from complete submission to final approval. TRICARE East requires recredentialing every three years to ensure ongoing compliance with TRICARE standards.Hover to read more

• Humana Military portal submission
• NPI + DEA coordination
• In-network contract execution

TRICARE West's credentialing for network participation is managed by TriWest Healthcare Alliance, the contractor responsible for the region. Providers seeking to join the TRICARE West network must complete TRICARE certification and credentialing, which involves submitting a credentialing application—including necessary licensure, training, board certification, professional background, malpractice history, and other documentation—to TriWest or its designated credentialing contact point. TriWest verifies this information against federal and TRICARE standards (including federal regulations like 32 CFR 199.6) and follows national credentialing standards such as URAC to determine whether a provider meets requirements for care of TRICARE beneficiaries. Providers must also sign a network participation contract with TriWest; credentialing approval and a fully executed contract are both required before a provider is considered in-network. Once complete, TRICARE West providers are authorized to see TRICARE beneficiaries and submit claims under the TRICARE program. Recredentialing typically occurs every three years to maintain active network status.Hover to read more

• URAC credentialing standards
• TriWest contract negotiation
• Federal compliance coordination

The VACCN credentialing process ensures that community healthcare providers meet professional, licensure, and quality standards before they can care for Veterans under the VA Community Care Network. Providers must complete an application and submit required documents—such as active professional licenses, education and training verification, board certifications, work history, malpractice history, and other pertinent credentials—for primary-source verification using a nationally accredited credentialing process administered through the VACCN contractor. This verification confirms a provider's qualifications and eligibility to join one of the regional VACCN networks managed by third-party administrators on behalf of the VA. Once credentialed and approved, providers are authorized to deliver care to Veterans and participate in the VA's community care reimbursement system. VACCN requires recredentialing at regular intervals (typically every 36 months) to ensure ongoing compliance with VA and industry standards.Hover to read more

• Nationally accredited verification
• Regional VACCN network placement
• VA reimbursement enrollment