When re-credentialing happens
- Commercial payers (NCQA): every 36 months.
- Medicare: revalidation every 5 years (3 years for DMEPOS).
- State Medicaid: every 3–5 years depending on the state.
- Hospital privileges: every 24 months.
The 90-day pre-flight checklist
- Confirm license expiration dates for every state the provider is credentialed in.
- DEA renewal is current (3-year cycle).
- Board certification is active — recertification cycles vary by board.
- Malpractice COI current, with the correct limits per payer contract.
- Refresh CAQH: re-attest, update work history, upload new documents, disclose any new sanctions or malpractice claims.
- Update the group roster with any new practice locations, hospital affiliations, or specialties.
- Verify NPI taxonomy matches the specialty the provider is billing.
What drops a provider off the panel
- Missed re-attestation on CAQH — payers can't pull the profile.
- Expired license, DEA, or malpractice COI on file.
- Undisclosed sanctions or Medicare exclusions (OIG/SAM/NPDB flags).
- Address / TIN mismatch between the group and Medicare PECOS / state Medicaid.
- No response to a payer's re-credentialing packet within its stated window (often 30 days).
Rolling re-credentialing calendar
Every group over ~10 providers should run a rolling calendar with a named owner. Track: provider, payer, next re-cred due date, next CAQH attestation date, license expiration, DEA expiration, malpractice COI expiration. Missing any one of these is the single biggest cause of unnecessary claim denials.
How Credify handles re-cred
Credify Health owns the rolling calendar for every provider we credentialed — CAQH attestation, payer re-cred packets, license and DEA renewals, and re-validation with Medicare and Medicaid. Related: CAQH ProView setup.