Use the credentialing checklist that matches your practice: adding a provider to an established group or opening a new practice. Both cover payer preparation and supporting documents. If you have engaged PPS, our provider onboarding checklist helps you organize what to send us.
Adding a provider to an established group
Prepare the provider and group
- Update the provider’s CAQH profile.
Add the new practice affiliation and start date, review the information, and attest. Confirm that the provider’s license and any required DEA registration cover the new practice location.
- Confirm the group’s payer list.
Include the commercial plans, Medicare Advantage plans, Medicaid managed care plans, workers’ compensation networks, TRICARE and third-party administrators with which the group participates. Confirm which networks the new provider will join.
- Gather the group’s tax information.
Prepare a signed Form W-9 and the IRS CP 575 or 147C letter verifying the group’s tax identification number. Supply the information requested by each payer and in CAQH.
- Confirm hospital arrangements.
Some specialties and payers require hospital privileges or an acceptable admitting arrangement. Record the relevant hospitals in CAQH and confirm the payer’s requirements before relying on a covering provider or hospitalist arrangement.
- Update malpractice coverage.
Confirm that the policy covers the new employment and identifies the provider’s coverage. Upload the current certificate to CAQH.
- Confirm the billing NPI.
Obtain the group’s Type 2 NPI and tax identification number for the applications. Keep the provider’s individual Type 1 NPI separate from the group’s billing information.
- Prepare the Medicare reassignment.
If the provider will bill Medicare through the group, gather the group’s Medicare enrollment information, including its PTAN, and complete the applicable reassignment through PECOS or the current CMS enrollment form.
Provider documents and access
Use this list to prepare for payer requests. The exact documents depend on the provider, specialty and enrollment scenario.
- Current professional state license.
- DEA registration for the appropriate practice location, if applicable. Confirm location and state requirements with the DEA before relocating or adding a location.
- State controlled-substance registration, if applicable.
- Board certification or proof of board eligibility, as requested by the payer.
- Professional liability insurance certificate showing the provider’s coverage. Track the expiration date and supply renewals during credentialing.
- Professional school diploma and completion certificates for internships, residencies and fellowships.
- CAQH profile ID and authorized practice-manager access, where supported. Use PPS’s secure onboarding process for any sensitive information needed to create a profile.
- Authorized access to PECOS through CMS Identity & Access Management (I&A), if Medicare enrollment is part of the work.
- Authorized user access to the state Medicaid portal and Availity, if applicable. Do not send passwords or authentication backup codes through a public form.
- Current CV with a complete education, training and work history. Supply exact dates when the payer requires them and explain relevant gaps.
- Hospital privileges or an acceptable admitting arrangement, when required. Include hospital name, staff category and appointment date if privileges are held.
Credentialing checklist for a new practice
Prepare a new practice for enrollment
- Establish the business and obtain its EIN.
Complete the business registration appropriate to your practice, then apply for an employer identification number with the IRS if required for the business.
- Save the IRS confirmation.
Keep the CP 575 EIN assignment notice with your practice records. Payers may request this notice or an IRS 147C verification letter.
- Confirm the service address.
You will need an accurate practice location for enrollment applications. Finalize the location early enough to keep your payer and directory information consistent.
- Apply for the appropriate NPI.
Organizations apply for a Type 2 NPI through NPPES; individual providers use a Type 1 NPI. A sole proprietor is an individual, not a separate Type 2 organization. PPS can help determine the applicable setup and arrange authorized access. See our NPI registration guide.
- Complete and attest the CAQH profile.
Update the provider’s professional and practice information. If you do not have a CAQH ID, start with our CAQH registration guide. Use the portal’s account-recovery options if access has been lost.
- Choose the payers that fit your practice.
Review local commercial PPOs and HMOs, Medicare and Medicare Advantage, Medicaid plans, workers’ compensation networks, TRICARE and relevant third-party administrators or networks. Prioritize participation based on your practice model and patients.
- Prepare Form W-9.
Use the current Form W-9 and its instructions for the taxpayer name, classification and identification number. The correct entries depend on the entity’s tax treatment; a disregarded entity may need its owner’s information.
- Confirm hospital or admitting requirements.
Identify whether your specialty and target payers require hospital privileges or a covering arrangement. Begin the hospital application or document an acceptable arrangement where required.
- Set up lasting practice contact information.
Use a business phone number and any required fax number in CAQH and payer applications. These details may appear in patient directories. A temporary or personal number creates more updates later.
- Arrange malpractice coverage.
Confirm the coverage required for your practice and payer applications. Discuss effective dates and any claims-made coverage transition with your insurer or broker, then upload the applicable certificate to CAQH.
- Authorize access to the CAQH profile.
Attesting the profile and granting access are separate actions. Make sure the participating plans you intend to work with are authorized to view the information.
- Gather state Medicaid documents.
Requirements depend on your state and provider type. Check the state’s current list for business registration, liability and workers’ compensation coverage, and a CLIA certificate or waiver if applicable.
- Submit and track each application.
Follow each payer’s current application process and retain confirmation or reference numbers. Medicare enrollment is available through PECOS; Medicaid enrollment is handled by the applicable state program. Track requests for additional information and confirm participation and effective dates before treating enrollment as complete.
Practice documents
Gather the items that apply to your business and target payers.
- IRS CP 575 or 147C letter, as applicable.
- Signed Form W-9 completed for the correct taxpayer and entity classification.
- Business license, if required in your service area.
- Fictitious name or assumed-name registration, if required.
- Articles of incorporation or organization, as applicable to the business structure.
- General or commercial liability insurance, as required.
- Workers’ compensation coverage, when required for the practice.
- CLIA certificate or certificate of waiver, if applicable.
- EFT bank verification letter or an acceptable voided check. See the Medicare bank letter example.
Provider documents and access
Prepare a separate set for each provider in the new practice.
- Current professional state license.
- DEA registration for the appropriate practice location, if applicable. Confirm location and state requirements with the DEA before relocating or adding a location.
- State controlled-substance registration, if applicable.
- Board certification or proof of board eligibility, as requested by the payer.
- Professional liability insurance certificate showing the provider’s coverage. Track the expiration date and supply renewals during credentialing.
- Professional school diploma and completion certificates for internships, residencies and fellowships.
- CAQH profile ID and authorized practice-manager access, where supported. Use PPS’s secure onboarding process for any sensitive information needed to create a profile.
- Authorized access to PECOS through CMS Identity & Access Management (I&A), if Medicare enrollment is part of the work.
- Authorized user access to the state Medicaid portal and Availity, if applicable. Do not send passwords or authentication backup codes through a public form.
- Current CV with a complete education, training and work history. Supply exact dates when the payer requires them and explain relevant gaps.
- Hospital privileges or an acceptable admitting arrangement, when required. Include hospital name, staff category and appointment date if privileges are held.
Working with PPS on credentialing
If PPS is managing your credentialing, request our onboarding checklist and complete the provider information form for each clinician. After you sign up, our team will provide instructions for securely sharing required documents and setting up authorized account access.
If your new organization needs a Type 2 NPI, PPS can help with that step as part of the agreed scope. We will confirm the enrollment setup that fits your practice.