Foundational credentials
Before any commercial or government payer enrollment, every new practitioner needs their personal baseline credentials in place.
Assigned to the clinician (MD, DO, NP, PA). Mandatory for every provider, even in pediatrics where Medicare patients aren't seen.
Assigned to the clinical entity or facility. Both are issued via NPPES, integrated with Medicare's I&A portal and PECOS.
Active and unrestricted in the practice's state of operation.
Individual certificate to prescribe Schedule II–V controlled substances.
An active policy — or formally bound onto the group policy — before payer credentialing.
NPs and PAs file through the Georgia Composite Medical Board under a supervising physician, who approves via reciprocal login.
CAQH ProView — the central profile
CAQH is the universal repository payers use for primary source verification: CV, education, residencies, board certifications, DEA, licenses and malpractice history.
CAQH profiles must be re-attested every 90 days. If an attestation lapses or a renewed license isn't uploaded immediately, insurers — especially state Medicaid — hold claims or issue automatic non-credentialed denials.
Payer application sequencing
It has the longest processing horizon — typically 60+ days of committee evaluation. Submission generates an ATN (Application Tracking Number).
1234567-A1234567-B1234567-CSame numeric root, unique letter suffix per physical location.
Via Availity → Payer Spaces → Credentialing / Join Network. ~5 minutes, pulls from CAQH, ~30 day turnaround.
Via the United Payer Portal. Requires a personal One Healthcare ID first.
Direct digital submission through each payer's network intake portal.
Requires prior Humana credentialing. Panels open only when geographic network gaps exist.
Healthpro credentialing pricing
Continuous 90-day attestations, license tracking and re-credentialing filings.
Fixed project fee per provider covering NPI, CAQH, GAMMIS, CMOs and major commercial panels.
Performance-based percentage of collected net revenue.
- Every provider needs a Type 1 NPI — no exceptions.
- Re-attest CAQH every 90 days and upload renewals immediately.
- Submit Georgia Medicaid first; it takes 60+ days.
- A base Medicaid ID doesn't cover Medicaid HMOs — enroll with each CMO.