When does credentialing have to start for a new provider?
Enter the start date, the provider type, the state and the payers you need. The planner works backward from day one and gives you a dated plan for each payer, a visual timeline and the document list. Download it as a PDF, add it to your calendar or email it to yourself.
Pick the payers and press Build my plan. A good rule: start 120 to 150 days before the first day, 180 for a new group.
- Start gathering documents
- First application due
- Last expected effective date
- Days until start
Timeline
Dates by payer
| Payer | Submit by | Expected effective | Start date |
|---|
"Submit by" is the latest date a complete application can go in and still be effective 14 days before the start, planning for the slow end of each payer's range. Status checks start 30 days after submission and repeat every 14 days; they are in the calendar file.
Key dates
Documents to gather
Payer notes
Check your inbox.
How the plan is built
No hidden rules. Every date comes from the start date, the payer's typical window and the situation you described.
- Typical window per payer. Calendar days from a complete application to an effective date, as a range. Medicaid uses the state's range (30 to 60 days for fast states, 60 to 90 days for most, 90 to 120 days for the slowest).
- Your situation adds days. CAQH not current: +14 days for commercial payers. New tax ID: +30 days for government payers (group enrollment first) and +45 days for commercial payers (contracting and fee schedule loading).
- Submit-by date = start date minus a 14-day safety buffer minus the slow end of the window and your extra days. If that date has passed, the plan uses today and shows the gap.
- Document gathering starts 5 days before the first submission when CAQH is current, 14 when it is not.
- Status checks at 30 days, then every 14 days until the expected effective date. Most delays are a missing item nobody asked about.
Why the gap costs so much
A provider who sees patients before a payer's effective date produces claims that payer will deny (CO-185 or B7: provider not eligible on the date of service). Those claims usually cannot be billed to the patient, and billing them under another provider's name is not allowed.
Medicare softens this with a retroactive effective date of up to 30 days before the application was received, and some Medicaid programs backdate too. Most commercial plans do not. The practical fix is to start early, submit complete applications and schedule the new provider's first weeks with the payers that are already effective.
Revelrex runs credentialing and enrollment for practices that want the applications, the follow-up calls and the tracking handled by someone whose only job is to get the effective date.
Hiring a provider this year?
A 30-minute call with a Revelrex credentialing specialist: we check the payer list, the CAQH profile and the start date, and tell you honestly whether the timeline works. No obligation.