CAQH Credentialing and ProView Profile Management
The profile every commercial payer pulls from
Credentialing playbook
Credentialing Audit and Expirables Management
A credentialing audit shows exactly where each provider stands with each payer, which documents are about to expire, and which enrollments are quietly broken. We audit the roster once, fix what we find, and then track every expirable so it never happens again.
About 4 minute read. Reviewed September 2026 by the ClainetRCM credentialing team.
On this page
- Overview
- Where it goes wrong
- What we handle
- What the audit deliverable looks like
- How the work runs
- Questions
- Read next
Want us to run it?
Send your roster and target payers; we map the gaps at no cost.
Most practices do not know their true credentialing status. Someone left, a spreadsheet stopped being updated, and now there are providers whose Medicaid ID lapsed, whose CAQH has not been attested in a year, and whose DEA renews next month with no one watching. The denials that result get worked one at a time without anyone connecting them.
ClainetRCM's credentialing audit builds a complete matrix of providers, payers, participation status, effective dates and expiration dates. Then expirables management keeps it current, with reminders and renewals handled before anything lapses.
- Every provider, every payer
- status matrix delivered in the audit
- Expirables
- licenses, DEA, malpractice, boards, CAQH, revalidations
- Free
- initial audit for practices evaluating our services
Where this usually goes wrong
Unknown participation status
Providers assumed to be in network are not, or are enrolled under the wrong Tax ID or location. Claims deny and staff cannot explain why.
Expiration dates nobody tracks
Licenses, DEA registrations, board certificates and malpractice policies all renew on different cycles. One expired document can stop payment from every payer.
Directory and roster errors
Payer directories list wrong locations or providers who left years ago, creating patient confusion and compliance exposure under directory accuracy rules.
What ClainetRCM handles
One coordinator owns the file from intake to effective date, so you always know who to call and what is outstanding.
- Provider roster inventory with NPI, licenses, DEA, boards and malpractice details
- Payer participation verification with each plan for each provider and location
- Effective date, re-credentialing date and revalidation date matrix
- Document expiration calendar with 90, 60 and 30 day reminders
- Correction of enrollment errors, wrong Tax IDs and outdated directory listings
- Quarterly audit refresh and monthly expirables report
What the audit deliverable looks like
| Provider matrix | One row per provider per payer: status, provider ID, effective date, next re-credentialing date, notes. |
|---|---|
| Expirables calendar | License, DEA, CDS, board certification, malpractice, CAQH attestation, Medicare and Medicaid revalidation, hospital reappointment. |
| Gap list | Every missing enrollment, lapsed participation and inconsistent record, prioritized by revenue impact. |
| Remediation plan | Dated actions for each gap, with owner and expected completion. |
The audit connects directly to re-credentialing, Medicare revalidation and our provider licensing service for renewals.
How the work runs
The sequence is the same for every payer and provider type; what changes is which documents and portals each step touches.
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Frequently asked questions
For a practice of up to ten providers, one to two weeks, most of which is waiting on payer verification responses. Larger groups are audited in phases by location or specialty.
A provider roster with NPIs, copies of current licenses and certificates if available, and any existing credentialing records. If the practice has nothing organized, we rebuild from NPPES, PECOS and payer verification.
For practices evaluating our credentialing or billing services, the initial audit and gap list are free. Ongoing expirables management is priced per provider. See pricing.
Every expiration date is loaded into our tracking system. We send reminders at 90, 60 and 30 days, gather the renewal documents, submit renewals where we are authorized to, and update CAQH and payers when new documents are issued.
Read next
NPI Registration and NPPES Record Management
Type 1 and Type 2 NPIs done correctly
Primary Source Verification Services
License, education, NPDB and sanction checks
Provider Re-Credentialing Services
Renewals before the panel drops you
Provider licensing
License, DEA and CSR renewals
Denial management
When credentialing gaps show up as denials
Group practices
Multi-provider rosters
Or return to the provider credentialing overview.
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.