CAQH Credentialing and ProView Profile Management
The profile every commercial payer pulls from
Credentialing playbook
Provider Credentialing Checklist
Applications are returned for missing documents more than for any other reason. This checklist covers what Medicare, Medicaid and commercial payers ask for, organized by provider type, so the file is complete before anything is submitted.
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About 4 minute read. Reviewed September 2026 by the ClainetRCM credentialing team.
On this page
- Overview
- Documents that most often hold up an application
- Core documents for every provider
- Additional documents by provider type
- 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.
Every payer application draws on the same core set of documents, with additions by provider type and by state. Gather them once, keep them current, and every application after that becomes a matter of process rather than a scramble. Missing or expired documents are the leading cause of returned applications and the main reason credentialing timelines stretch past 150 days.
Use this checklist to assemble your file. If you would rather hand it to us, we collect and verify every item as the first step of any credentialing engagement.
Documents that most often hold up an application
Work history gaps
Payers require a month-by-month work history and an explanation for any gap longer than a few months. Unexplained gaps go straight to development.
Malpractice face sheet, not the policy
Payers want the certificate of insurance showing limits and dates, not the full policy. An expired face sheet is treated as no coverage.
Supervision and collaboration agreements
NPs, PAs and some therapists must provide collaborative or supervision agreements where the state requires them. Applications without them are returned.
Core documents for every provider
These are required by nearly every payer regardless of specialty.
- Current state license(s) with expiration date
- DEA registration and state controlled substance registration where applicable
- Board certification or eligibility letter
- Malpractice certificate of insurance with limits and policy dates
- Curriculum vitae with month and year for every position and explanations for gaps
- NPI confirmation, Social Security number and government-issued photo ID
- Diploma and residency or training completion certificates
- W-9 for the billing entity and voided check or bank letter for EFT
- Hospital privileges letter or admitting arrangement where the specialty requires it
- Completed disclosure questions with written explanations for any yes answers
Additional documents by provider type
| Physicians (MD/DO) | ECFMG certificate for international graduates, fellowship certificates, hospital privileges or coverage arrangement. |
|---|---|
| Nurse practitioners | RN and APRN licenses, national certification (AANP or ANCC), prescriptive authority, collaborative agreement where the state requires it. See NP credentialing. |
| Physician assistants | NCCPA certification, state PA license, supervision agreement. See PA credentialing. |
| Behavioral health | License type and number, supervised hours documentation for newly licensed clinicians, specialty certifications. See therapist credentialing. |
| Facilities and groups | Articles of organization, EIN letter, Type 2 NPI, CLIA certificate for labs, state facility license, ownership disclosure. See business registrations. |
| Dental | State dental license, anesthesia permit where applicable, specialty certificate. See dental credentialing. |
All of these are stored and kept current in CAQH ProView for commercial payers.
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
Licenses, DEA and malpractice must be unexpired at the time of review and, for most payers, at the time of the committee decision. CAQH attestation must be within 120 days. We track every date so nothing is stale when the payer looks.
No. Clear digital copies are accepted everywhere. Payers verify at the primary source, so what they need from you is accurate information and legible copies. See primary source verification.
Disclose it, with a clear written explanation and any resolution documents. Payers verify against the NPDB and state boards, so non-disclosure is discovered and is far more damaging than the event itself.
Yes. Document collection and verification is the first step of every engagement, and we store the file so every future application, re-credentialing and revalidation starts from a complete set.
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
Licenses and DEA on the checklist
Healthcare business registrations
Entity documents for groups
Free resources
Downloadable guides
Or return to the provider credentialing overview.
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