Free printable checklist · Cima Consulting
Credentialing documents checklist: what insurance plans ask for
To apply to an insurance network, each clinician needs a current license, an individual NPI, an attested CAQH ProView profile, a CV with month and year for every job, diplomas, a malpractice declarations page and a signed W-9. The practice adds its IRS EIN letter, organization NPI, formation documents, an ownership list and a bank letter for direct deposit. A treatment program adds its state facility license, certificate of occupancy, fire inspection, liability certificate, key staff and, for many plans, accreditation. Every item, and why plans want it, is below.
Updated October 24, 2026. This is the same document list we gather for our own credentialing clients.
Before you start
- Make one folder and keep it current. Most delays come from a missing page or a name that doesn't match the IRS letter, not from the plan. Scan each document as a clean PDF, named by what it is and when it expires.
- Some details are typed, never emailed. Social Security number, date of birth, home address and place of birth go into CAQH and the plan's secure portal. Don't send them, or copies of IDs, by ordinary email.
- CAQH first. Most commercial plans read your CAQH ProView profile instead of a paper application, so nearly every clinician document below gets uploaded there once. Medicare (through PECOS) and Texas Medicaid (through TMHP) have their own enrollment systems.
- Unsure what a term means? The behavioral health business glossary covers CAQH, NPI types, taxonomy, PECOS, PTAN, TMHP and the rest. The process around these documents is on our credentialing service page.
Cima Consulting · consulting.cimaehr.com/checklists/credentialing-documents-checklist
Credentialing documents checklist
Clinician or practice: ________________________Plans applying to: ________________________Date: ____________
Every clinician 15 items
For each person who will see the plan's members, including associates and interns.
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Every state license you hold. Plans verify it with the board (in Texas, LPC, LMFT, LCSW and psychologist licenses on the Behavioral Health Executive Council; nurse practitioners on the Board of Nursing). Associates and interns: your supervisor's name and license too.
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Keep your CAQH provider ID handy. Plans can't use a profile that hasn't been re-attested in the last 120 days, and a plan you haven't authorized can't see it at all.
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Since training, with no unexplained holes. Write a short explanation of any gap longer than 3 months; some plans ask about shorter ones.
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Transcripts only if a board or plan asks for them.
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Optional for most therapists; usually expected for physicians and psychiatric nurse practitioners.
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The page showing your name, limits and policy dates. Many plans ask for $1 million per claim and $3 million a year. List any malpractice claims or settlements with dates and outcomes; a disclosed claim is a question, an undisclosed one is a problem.
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Every application asks about license actions, malpractice, criminal history, sanctions and exclusions. Answer the same way everywhere, with a short written explanation for any "yes".
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A driver's license or state ID, uploaded to the plan's or CAQH's secure portal.
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Typed into secure forms, not sent as attachments. Plans use them to check identity and exclusion lists.
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Texas LPCs and LMFTs: since March 2024, Texas Medicaid has required Medicare enrollment before Medicaid enrollment, unless you qualify for the pediatric exemption (BCBSTX Medicaid notice).
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The approved supervisor, the signed agreement or board form, and the schedule. Plans differ on whether they panel associates; ask each one before you apply.
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So nobody re-applies to a plan you're already in, and so a group application can link you to contracts you hold.
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With your legal name and the tax ID claims will be paid to. If the practice is paid, use the practice's W-9 instead (below).
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You attest that everything is true and let plans verify your education, training, licensure and history. You sign every application and contract yourself, even when someone prepares them for you.
Prescribers: add these 4 items
Physicians, psychiatric and family nurse practitioners, and physician assistants.
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For each state where you'll prescribe controlled substances, from the DEA Diversion Control Division.
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In Texas, the Texas State Board of Pharmacy PMP.
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Signed with your delegating physician, plus the physician's name, Texas license number and NPI, and confirmation that the delegation is registered with the Texas Medical Board.
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Needed for instant urine drug screens and other waived tests (CMS CLIA).
The practice or group 11 items
When claims are paid to a company (a PLLC, LLC or corporation), the company is credentialed or linked too.
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Plans match the legal name on it, character for character, against every other form. Lost it? Ask the IRS for a 147C.
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The legal name and EIN exactly as on the IRS letter.
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Tied to the EIN. The authorized official on it must be someone who can legally bind the company. See NPI in the glossary.
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Certificate of formation from the Texas Secretary of State, the company agreement or bylaws, and the DBA filing if you use another name.
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Name, title and ownership percentage for each, with photo ID. Medicare and many plans ask about everyone who owns 5% or more.
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Showing the account holder's legal name, routing and account number, for direct deposit (EFT).
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Most plans need a physical address where services happen, even for telehealth, and many don't accept virtual mailboxes. Use the same address on NPPES, CAQH and the W-9 mailing line.
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And any other business policy you carry. Plans and landlords often set minimum limits.
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For each clinician: full name, credential, license number and state, NPI, CAQH ID, start date, full- or part-time, employee or contractor.
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In PECOS, so the practice is paid for each clinician's Medicare visits. There's no Medicare application fee for individual clinicians or clinician groups.
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Then a separate application to each Medicaid managed care plan in your area. Their primary-source checks run through one credentialing verification organization (TAHP).
A facility (IOP / PHP program): add these 11 items
Programs apply for a facility contract as an organization. Ask each plan whether it also credentials your clinicians.
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In Texas, the HHSC chemical dependency treatment facility license for an SUD program. Most plans won't take a facility application until it's issued.
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Joint Commission, CARF or COA. TRICARE requires it for IOP and PHP, and many commercial plans contract with programs only once they're accredited. Send the letter to every plan the day it arrives.
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Plans often set minimum limits for facilities; ask before you buy the policy.
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The address on the license, the NPI and the application must match.
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From the city, for outpatient health care use.
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From the fire marshal, or the date it's scheduled.
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Services, levels of care, hours per week, ages served and planned capacity. Plans load your levels and codes from it.
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Program director, clinical director, medical director and lead clinicians or nurses, plus a staff roster with license numbers.
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Who governs the program and how often they meet, and who reports to whom, by title.
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Some plans ask for policies with the application; a floor plan with room uses, exits and restrooms helps at the site visit.
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Many plans visit a new facility before contracting: signs up, records locked, rights posted, emergency plan and drill log on hand.
Keeping it current 4 items
Credentials lapse quietly. Put each date on a calendar.
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With new license, malpractice and DEA dates uploaded as they renew.
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A missed request can drop you from the network.
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CMS posts your due date; revalidate in PECOS.
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Online in PEMS; HHSC suggests filing at least 120 days before the due date, and a missed revalidation ends your enrollment (HHSC).
As of October 24, 2026. Each plan sets its own list and may ask for more. Cima Consulting isn't a law firm and doesn't sign applications for you.
Five mismatches that stall a file
Plans compare your documents against each other. When two disagree, the application stops until you fix it, often without telling you.
| Mismatch | Where it shows up | The fix |
|---|---|---|
| Legal name | "Smith Counseling PLLC" on the W-9, "Smith Counseling, PLLC" on the IRS letter | Copy the IRS letter exactly into NPPES, CAQH, the W-9 and the bank account |
| Service address | NPPES still shows a home address; the application shows the office | Update NPPES and CAQH first, then apply |
| Taxonomy | The NPI's taxonomy doesn't match the license or the specialty you applied under | Set the taxonomy in NPPES to match the license |
| Expired document | The malpractice page or license in CAQH expired last month | Upload the renewal and re-attest the same day |
| Work history gap | The CV jumps from one year to the next with no months | Month and year for everything, and a line explaining each gap |
Where each document goes
| Where | What it takes |
|---|---|
| CAQH ProView | Nearly the whole clinician list: license, NPI, CV, education, malpractice, disclosures, ID and the plans you authorize. Read by most commercial and Medicaid managed care plans. |
| PECOS (Medicare) | Each clinician, the practice and the reassignment; licenses, NPI, ownership and bank details. LPCs and LMFTs have been able to enroll since January 1, 2024 (CMS). Freestanding IOP and PHP programs generally can't bill Medicare for those levels. |
| TMHP PEMS (Texas Medicaid) | The practice or facility, its clinicians, ownership and license; then each managed care plan's own application. |
| Each plan's portal | The participation request, the W-9, the facility documents and, for programs, the policies and site visit. Many run through Availity. |
How long plans take
From a complete application to in-network, by kind of plan, from our own credentialing records. Plans set their own pace; these are typical ranges, not promises.
| Plans | Typical time | Reads CAQH |
|---|---|---|
| Commercial plans Aetna, Cigna / Evernorth Behavioral Health, UnitedHealthcare / Optum Behavioral Health, Blue Cross and Blue Shield of Texas | 45–120 days | Yes |
| Medicare (PECOS) | 30–90 days | No |
| Medicare Advantage plans Humana (Medicare Advantage), Medicare Advantage plans | 60–120 days | Yes |
| Texas Medicaid (TMHP) | 30–60 days | No |
| Texas Medicaid and CHIP managed care plans Superior HealthPlan, Wellpoint Texas (formerly Amerigroup), Molina Healthcare of Texas, Community Health Choice and 9 more | 60–120 days | Yes |
| Marketplace plans Ambetter (marketplace), Oscar Health (marketplace) | 60–120 days | Yes |
| Behavioral health managers Magellan Healthcare, Carelon Behavioral Health (formerly Beacon Health Options) | 60–120 days | Yes |
| Employee assistance and benefit networks ComPsych (EAP), Lyra Health, Spring Health | 30–90 days | No |
| TRICARE and VA Community Care TRICARE, VA Community Care Network | 60–120 days | No |
Programs: these clocks start only once the state license is issued. Our IOP opening checklist shows where credentialing falls in the whole launch, and the IOP guide's credentialing section explains Medicaid, Medicare and TRICARE for programs.
Having it done for you
On our credentialing service, we gather this folder once in your client portal, build and attest CAQH, file each plan complete, follow up every two weeks and get each effective date in writing. Flat prices, never a share of what you bill:
| Service | Price |
|---|---|
| CAQH ProView profile Your CAQH profile built from your documents, uploaded, authorized for your payers and attested. Includes: Profile built and documents uploaded; Payers authorized to view it; First attestation. | $250 per clinician |
| Credentialing: one insurance plan One clinician with one insurance plan, from application to effective date. Includes: Application filed; Follow-up every 2 weeks until decided; Contract review checklist (rates, timely filing, termination); Effective date confirmed and loaded in your EHR. | $175 per plan |
| Medicare enrollment (PECOS) Medicare enrollment for an individual clinician, with reassignment to your group. Includes: PECOS application; Reassignment to the group; Revalidation date tracked. | $350 per clinician |
| Medicaid enrollment State Medicaid enrollment and the first managed care plan. Includes: State enrollment (Texas: TMHP); One Medicaid managed care plan; Revalidation date tracked. | $350 per clinician |
| Facility or group contract: one plan A program or group contract with one insurance plan: the organization application, site visit and contract. Includes: Organization application; Site visit preparation if the plan does one; Contract and rate review checklist; Effective date and billing set-up confirmed. | $450 per plan |
| Credentialing upkeep We keep every clinician's credentials current, every month. Includes: CAQH re-attestation every 120 days; License, malpractice and DEA expirations tracked and renewed on time; Recredentialing and Medicare / Medicaid revalidation; Address, phone and roster changes sent to every plan. | $49 per clinician a month |
A solo clinician with CAQH and four plans comes to $950. Opening a whole practice? The Solo Practice: Complete and Group Practice launches include credentialing, and the IOP / PHP Program Launch includes the facility contracts.
Questions
What documents do I need for insurance credentialing?
For a clinician: license, individual NPI, CAQH profile, CV with months and years, diploma, malpractice declarations page, photo ID and a W-9. For the practice: IRS EIN letter, W-9, organization NPI, formation documents, owners list, bank letter and service address. Programs add the facility license, certificate of occupancy, fire inspection, liability certificate, key staff and accreditation.
Do I need CAQH to get credentialed?
For most commercial and Medicaid managed care plans, yes: they read your CAQH ProView profile instead of a paper application, and it must be attested within the last 120 days. Medicare (PECOS) and Texas Medicaid enrollment (TMHP) don't use CAQH.
Can I start credentialing before my practice address is final?
You can build CAQH and gather documents, but don't submit plan applications until the service address is real. Plans load the address into their directories and contracts, and changing it later means more paperwork and delay.
Do associates and interns get credentialed?
Plans differ: some credential associates under a supervisor, others don't. Ask each plan before you apply, and keep the supervision agreement and the supervisor's license in the file.
Does a facility contract cover my clinicians?
It depends on the plan. Some contract the program as a facility and bill everything under it; others also credential each clinician. Ask at the start, because it changes whose documents you gather.
Rather hand over the folder?
We build CAQH, file each plan and follow up every two weeks until there's a decision. $175 per plan, flat.
Or book a free 30-minute call and tell us which plans you want. More free lists: all our checklists.
Sources
- Cima Consulting's credentialing document request and payer directory, as of October 24, 2026.
- CAQH ProView; CMS, NPPES and PECOS; CMS, Marriage and family therapists and mental health counselors
- TMHP; HHSC, Medicaid provider revalidation; Texas Association of Health Plans, Credentialing 101 (Fall 2024)
- Blue Cross and Blue Shield of Texas, Medicare enrollment required for LPCs and LMFTs (May 14, 2024)
- Texas Behavioral Health Executive Council; Texas Board of Nursing; DEA Diversion Control Division; Texas PMP; TRICARE
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