20 Best Practices for Credentialing & Contracting with Insurance Companies
Let’s be honest—credentialing and contracting with insurance companies is a headache. It’s slow, frustrating, and full of confusing paperwork. And if you get it wrong? Expect delays, denied claims, and lost revenue.
But here’s the good news—you don’t have to get stuck in credentialing limbo. With the right strategies, you can speed up approvals, negotiate better rates, and avoid common mistakes that cost practices thousands.
I’ve put together 20 best practices to help you streamline credentialing and payer contracting—so you can get in-network faster and start getting paid. Let’s dive in!
Key Takeaways:
- Gather all required documents upfront to avoid delays.
- Update your CAQH & NPI details regularly to prevent automatic rejections.
- Assign a credentialing coordinator or outsource to stay on track.
- Follow up with insurance companies every two weeks—don’t wait for them to call you.
- Negotiate reimbursement rates before signing contracts—don’t settle for low offers.
- Check payer directories quarterly to ensure your listing is accurate.
- Track re-credentialing deadlines so you don’t get deactivated.
- Use credentialing software to automate tracking and avoid manual errors.
- Set up EFT & ERA enrollments for faster payments.
- Audit claim denials monthly to catch credentialing-related errors early.
Preparing for Credentialing
Let’s be real—most credentialing delays happen before you even hit “submit.” A missing document, an outdated CAQH profile, or even a simple typo in your NPI number can put your application on hold for months.
To create a CAQH profile, register for an account at the CAQH Provider Data Portal and initiate the application process.
The key? Get everything in order BEFORE you apply. The smoother your application, the faster your approval. Here are five essential steps to make sure you don’t get stuck in credentialing limbo.
1. Gather & Verify Required Documents in Advance
Think of credentialing like airport security—you can’t board the plane if you don’t have all the right documents. Insurance companies won’t process your application if even one thing is missing.
What you’ll need:
- Medical license
- DEA certificate (if applicable)
- Malpractice insurance details
- Board certifications
- NPI number (National Provider Identifier)
- Tax ID & W-9
- CAQH profile (we’ll get to that next!)
Pro Tip: Keep all of these in a secure digital folder (Google Drive, Dropbox, or a credentialing software) so they’re always updated and accessible. That way, when you need them, you won’t be scrambling.
2. Stay Proactive with CAQH & NPPES Updates
If your CAQH profile isn’t up to date, some payers won’t even look at your application. Many providers don’t realize that payers pull credentialing data directly from CAQH, so any outdated info can lead to automatic denials.
Keep these updated:
- CAQH attestation (must be re-attested every 90 days)
- Work history & malpractice coverage (no gaps!)
- NPPES (make sure your NPI and address match exactly across all documents)
Pro Tip: Set a calendar reminder every 3 months to log in and re-attest CAQH—don’t wait for an insurance company to tell you it’s outdated!
3. Assign a Dedicated Credentialing Coordinator (Or Outsource It!)
Who’s handling credentialing in your practice? If the answer is “everyone and no one,” you’ve got a problem. Without a single person tracking applications, things fall through the cracks.
Your options:
- Hire a credentialing specialist (if your practice is large enough).
- Assign an in-house team member to manage credentialing full-time.
- Outsource to a credentialing service (worth it if you’re short on time).
Pro Tip: If you outsource, choose a service that tracks payer application status for you—some companies just submit forms and leave you in the dark.
4. Verify Payer Enrollment Timelines Before Applying
Did you know that some payers only process applications once per quarter? That means if you miss the deadline, you’re waiting another 3 months before they even start looking at your application.
Before applying, check:
- Does the payer have enrollment windows (quarterly, biannual, etc.)?
- What’s the average processing time for that insurer?
- Do they require credentialing and contracting to be submitted separately?
Pro Tip: Call provider relations and ask, “When is the next credentialing cycle, and what’s the average approval time?” Getting this info up front can save you months of waiting.
5. Use a Standardized Credentialing Checklist for Every Provider
Every insurance company asks for different things, which makes credentialing a nightmare. The fix? Create a standardized checklist for your practice so that every provider submits the same complete application.
What to include:
- Required documents (licenses, insurance, CAQH attestation, etc.)
- Any payer-specific forms that must be submitted
- Internal deadlines for each step of the process
Pro Tip: Keep a master checklist for each provider and track their progress in a shared document or credentialing software. This way, nothing gets overlooked.
Set Yourself Up for Success
A smooth application starts before you even submit. If you have all your documents, your CAQH is updated, and your team is organized, you’ll fly through the credentialing process instead of getting stuck in delay after delay.
Up next: Let’s talk about how to submit applications the RIGHT way and avoid getting lost in payer backlogs!
Submitting Credentialing Applications
Alright, you’ve got all your documents ready, your CAQH is updated, and you know exactly when to apply—so what’s next? Now comes the tricky part: actually submitting your credentialing application and making sure it doesn’t get lost in the insurance company’s black hole.
The good news? There are ways to speed things up and avoid common mistakes that slow down approvals. Here’s what you need to know to get your application processed quickly and correctly.
6. Submit Applications Electronically Whenever Possible
Paper applications are the enemy of speed. They take longer to process, can get lost in the mail, and require more manual handling by insurance companies (which means more chances for mistakes).
Why electronic submissions are better:
- They get processed 30% faster than paper.
- You receive instant confirmation that the application was received.
- Some payers allow real-time tracking of your application status.
Pro Tip: Before you start, check if the payer has an online credentialing portal. Many insurers require online applications now—don’t waste time mailing paperwork if there’s a faster option!
7. Follow Up on Application Status Regularly
Here’s something insurance companies won’t tell you: If there’s a mistake or missing document in your application, they probably won’t call you. It will just sit in their system untouched for weeks—until YOU reach out.
How often to check in:
- Call every two weeks after submitting your application.
- Ask, “Is anything missing? Is there anything I can provide to speed things up?”
- Document who you spoke to and what they said—this helps if you need to escalate the issue later.
Pro Tip: Create a credentialing follow-up log in a spreadsheet so you can track payer responses, dates, and next steps.
8. Ensure All Locations & Tax IDs Are Correct
It sounds obvious, but incorrect provider or practice information is one of the most common reasons for credentialing delays. A wrong NPI, mismatched TIN, or outdated address can send your application straight to the rejection pile.
Common mistakes to avoid:
- Group NPI vs. Individual NPI mix-ups (make sure they’re entered correctly).
- Wrong Tax ID (TIN)—use the one linked to your contract.
- Using an old address that doesn’t match what’s on your CAQH or W-9.
Pro Tip: Before submitting, cross-check all details against your CAQH, NPPES, and tax records to make sure they all match. Insurance companies love consistency.
9. Request a Payer Representative for Your Region
Most providers don’t know this, but some insurance companies assign dedicated representatives to handle credentialing and contracting in different states or regions. If you can get a direct contact, it can save you a TON of time.
Why this matters:
- A payer rep can push your application through faster.
- If there’s an issue, they can tell you exactly what’s wrong and how to fix it.
- You won’t have to sit on hold for hours with customer service every time you call.
Pro Tip: Call provider relations and ask, “Do you have a dedicated representative for our region that I can speak with about credentialing?” If they do, get their name, email, and direct number.
10. Track Credentialing Expirations to Avoid Gaps
Think credentialing is a one-and-done process? Nope. Most payers require re-credentialing every 2-3 years, and if you miss it, you could get deactivated without warning—which means denied claims and lost revenue until you reapply.
How to avoid lapses:
- Set automatic reminders 6 months before re-credentialing deadlines.
- Regularly check payer websites or provider portals for notices.
- Assign one person (or software) to track expiration dates for all providers in your practice.
Pro Tip: Use credentialing software (like Modio Health or CACTUS) to automate tracking so you never miss a deadline.
Don’t Let Your Application Disappear
Submitting your credentialing application is just the first step—the real work is following up, fixing errors quickly, and keeping payers accountable for processing your application on time.
Your next step:
- Submit applications electronically whenever possible.
- Follow up every two weeks (because insurers won’t remind you if there’s an issue).
- Make sure your NPI, TIN, and addresses match across all documents.
- Get a payer rep’s contact info to escalate issues faster.
Up next: We’re diving into contracting with payers—how to negotiate rates, avoid bad contract terms, and make sure you actually get paid what you deserve!
Contracting with Payers
Getting credentialed is only half the battle—now it’s time to sign the contract and make sure you actually get paid.
Here’s the problem: Many providers accept the first contract offer without question. They don’t realize that payer contracts are negotiable and often include hidden clauses that could lower reimbursement rates over time.
The good news? You can negotiate better rates, avoid bad contract terms, and ensure a smooth transition to in-network status. Here’s how.
Contracting With Payers: Understanding Different Plans
11. Negotiate Reimbursement Rates Before Signing
Most providers assume reimbursement rates are fixed, but here’s the secret—insurance companies expect you to negotiate. If you don’t push for better rates, you’re likely accepting a lowball offer.
How to negotiate:
- Never accept the first offer—always ask for 110-120% of Medicare rates as a starting point.
- If you have a high patient volume, use that as leverage to ask for better rates.
- Research other providers’ contracted rates in your area to compare.
Pro Tip: Payers are more likely to increase rates if you show them your value—for example, high patient satisfaction, low ER referrals, or unique specialty services.
12. Review the Contract for Hidden Clauses
Payer contracts are often filled with fine print that could cost you thousands if you don’t catch it before signing.
Red flags to watch for:
- Automatic fee schedule changes (some contracts allow payers to reduce your rates without notice).
- Unilateral contract amendments (the insurer can change terms at any time without renegotiation).
- Non-compete clauses (could limit where you practice if you leave the network).
Pro Tip: Have a healthcare attorney or contract specialist review the agreement before signing. A bad contract can lock you into low payments for years.
13. Confirm Credentialing & Contracting Are Linked
Just because you’re credentialed doesn’t mean you’re ready to bill. Some payers require separate approval for contracting—and if you miss that step, your claims will get denied.
What to check before billing:
- Make sure your contract’s effective date matches your credentialing approval date.
- Verify that your practice locations and NPIs are fully linked in the payer’s system.
- Confirm that you’re listed as in-network in the provider directory before seeing patients.
Pro Tip: Always get the contract’s effective date in writing—some payers delay activation, which means you won’t get reimbursed for services provided in the gap.
14. Renegotiate Rates Regularly (Don’t Get Stuck with Low Reimbursements!)
Signing a contract isn’t the end of the negotiation process—many practices go years without reviewing their reimbursement rates, losing thousands in potential revenue.
When to renegotiate:
- If your patient volume with a payer increases, use that as leverage to request higher rates.
- If Medicare rates increase, use that as a benchmark to push for adjustments.
- If you expand services (new locations, specialties, procedures), bring that to the table for renegotiation.
Pro Tip: Set a calendar reminder every year to request a rate review—payers won’t voluntarily increase your rates unless you ask.
15. Keep Copies of Signed Contracts & Fee Schedules
Many practices lose track of their contracts—and when a reimbursement issue comes up, they have no idea what their actual rates should be.
What to keep on file:
- Signed contracts for each payer.
- The most recent fee schedule (payers sometimes lower rates without notifying you).
- Any amendments or correspondence about rate adjustments.
Pro Tip: Store digital copies of all payer contracts in a shared, secure folder (Google Drive, Dropbox) so they’re easily accessible when needed.
Don’t Sign a Bad Deal
Payer contracts set the foundation for your revenue—if you accept bad terms, it’s going to hurt your bottom line for years.
Your next step:
- Negotiate rates BEFORE signing (never accept the first offer).
- Read the fine print (hidden clauses can cost you big time).
- Confirm that credentialing and contracting are fully linked before billing.
- Review your contracts annually—you won’t get better rates unless you ask.
Up next: Managing your credentialing after approval—how to avoid deactivation, keep payers from messing up your listing, and ensure smooth reimbursement.
Managing Ongoing Credentialing & Compliance
Getting credentialed and signing a payer contract isn’t the finish line—it’s just the beginning.
Insurance companies love finding reasons to delay payments or deny claims, and one of the biggest culprits? Credentialing lapses, incorrect provider listings, and outdated payer records. If you’re not actively managing your credentials, you could lose in-network status without warning—and that means months of unpaid claims while you scramble to fix it.
Want to avoid getting dropped, stay compliant, and keep reimbursements flowing? Here’s how.
16. Implement a System for Ongoing Recredentialing
Most payers require recredentialing every 2-3 years, but they won’t always remind you. If you miss the deadline, they can deactivate you—without notice.
How to stay on top of re-credentialing:
- Track expiration dates for each payer in a shared credentialing log.
- Set automatic reminders 6 months before re-credentialing is due.
- Use credentialing software (like Modio Health, CACTUS, or Verity) to automate tracking.
Pro Tip: Some payers take months to process recredentialing applications. Start at least 180 days in advance so you don’t lose in-network status.
17. Monitor Payer Directories for Accuracy
Did you know payer directories are often wrong? That’s right—your practice could be listed with the wrong address, old phone number, or even missing from the directory altogether. And guess what? If a patient tries to find you and your listing is incorrect, they might go somewhere else.
How to keep your information accurate:
- Check your provider listing on payer websites at least quarterly.
- If you find errors, submit corrections immediately to provider relations.
- Keep records of every correction request (because insurers love “losing” them).
Pro Tip: Some insurance companies will deny claims if your office address or TIN doesn’t match their records—always make sure everything is consistent.
18. Set Up EFT & ERA Enrollments for Faster Payments
Are you still waiting for paper checks in the mail? You could be getting paid weeks faster with electronic funds transfer (EFT) and electronic remittance advice (ERA).
Why EFT & ERA are a game changer:
- Faster payments (no more waiting for checks to clear).
- Better tracking of claims and denials.
- Eliminates “lost check” delays (because yes, that happens).
Pro Tip: Some payers charge fees for EFT enrollment (yes, really 🙄). Check for free options before signing up.
19. Regularly Audit Claims for Credentialing Errors
Even if your credentialing is up to date, insurance companies make mistakes—and that can lead to denied claims with no warning.
How to catch credentialing-related denials early:
- Run a monthly audit on all claim denials.
- Look for rejection codes related to “provider not credentialed” or “not in-network.”
- If you see these errors, contact the payer immediately to correct their records.
Pro Tip: Keep a credentialing denial log so you can track payer errors and dispute claims faster.
20. Stay Updated on Payer Policy Changes
Insurance companies change the rules constantly, and if you’re not keeping up, you could get hit with unexpected denials or new credentialing requirements.
How to stay informed:
- Sign up for payer newsletters & provider bulletins.
- Attend payer webinars (they often announce policy changes there first).
- Join provider forums or credentialing groups to stay in the loop.
Pro Tip: If a payer announces a policy change that affects reimbursements, reach out to provider relations before it takes effect to understand the impact.
Stay Credentialed, Stay Paid
Credentialing isn’t just a one-time process—it’s an ongoing part of your revenue cycle. If you’re not actively managing your credentials, checking payer directories, and staying ahead of re-credentialing deadlines, you’re putting your reimbursements at risk.
Your next step:
- Track credentialing expirations so you never get deactivated.
- Check your payer directory listings to ensure accuracy.
- Set up EFT & ERA payments to speed up reimbursements.
- Audit claim denials monthly to catch payer errors early.
Up next: Let’s talk about how to keep the money flowing—tips for tracking reimbursements, disputing claim denials, and making sure payers actually pay you on time!
Credentialing Doesn’t Have to Be a Nightmare
If you’ve ever felt like insurance companies make credentialing harder than it needs to be—you’re not alone. The process is slow, full of red tape, and if you’re not paying attention, you could lose months of reimbursements over a simple mistake.
But now, you have a game plan.
- Get organized before you apply—missing documents cause most delays.
- Follow up every two weeks—because payers won’t remind you if there’s a problem.
- Negotiate your contract rates—don’t accept the first offer.
- Keep track of re-credentialing deadlines—so you don’t get dropped without warning.
The bottom line? If you’re proactive instead of reactive, you’ll avoid the most common headaches, get credentialed faster, stay in-network, and actually get paid on time.
Which tip are you going to implement first? Let me know—I’d love to hear how it helps!