Add a new provider to a practice's roster

For: Credentialing Coordinator · Time: 20–30 min per provider · Frequency: Variable (new hires at practices, new provider type added)

Trigger

A practice hired a new provider OR an existing provider gained a new credential (e.g. completed residency, obtained DEA). The provider needs to exist in Credentik so applications can be drafted and the practice can eventually bill for them.

Outcome

The provider record exists with NPI, taxonomy, specialty, at least one current state license, malpractice info, and a document folder with starter docs (CV, board cert, license PDF, DEA if applicable).

Where

• Providers — list + create
• Provider detail — all sub-tabs (Profile, Licenses, Education, Boards, Documents, Applications)
• NPI Registry — primary source (the platform proxies this)

Steps

1. Providers → New Provider. Enter NPI first. The platform calls NPPES and pre-fills name, gender, addresses, taxonomy, mailing/practice locations. Verify the data matches what the practice told you.
2. Confirm taxonomy. Behavioral health taxonomies are nuanced. Common ones:
   • 2084P0800X — Psychiatry
   • 2084P0805X — Geriatric psychiatry
   • 2084P0802X — Child & adolescent psychiatry
   • 103T00000X — Psychologist
   • 101YA0400X — LCSW
   • 101Y00000X — Counselor
   • Use Reference → Taxonomy Codes to look up. Picking the wrong one can trigger denials downstream.
3. Save provider. The record is now active in Credentik.
4. Add state licenses. Provider detail → Licenses tab → New. One per state. For each: license #, state, type (medical, psychology, social work, counseling), issue date, expiration date. Upload the certificate PDF.
5. Add DEA registrations if the provider prescribes. Provider detail → DEA tab → New. One per state.
6. Add education. Education tab. Medical school + residency, with year graduated. Some payers won't accept applications without this.
7. Add board certifications. Boards tab. ABPN, ABPP, board specialty, certified date, expiration if applicable.
8. Add malpractice insurance info. Profile → Malpractice. Carrier, policy #, coverage limits, expiration. Upload the COI (Certificate of Insurance).
9. Upload starter docs. Documents tab → CV, signed W-9, signed practice agreement. These get pulled into application packets later.
10. Tie to organizations. If the provider works at multiple practices, link them. Provider detail → Organizations → Add. Each tie creates a provider_organization row used by claim entry to know who can bill under which TIN.
11. Run PSV → playbook. This is now part of the provider's compliance posture, separate from any single application.

Watch-outs

• NPI lookup misses brand-new NPIs. NPPES updates daily but new issuances can take 48 hours to appear. If a provider just got their NPI yesterday, retry tomorrow before manually entering.
• Mid-licensure providers (residents, fellows, intern-supervised). Some can bill incident-to, some can't, some only under specific Medicare rules. Don't add them as fully-credentialed; tag them with the supervised flag in Profile so the RCM team knows to bill under the attending.
• Group NPIs vs individual NPIs. Practices sometimes have a group NPI (type 2) for billing. The PROVIDER you're adding has an individual NPI (type 1). Don't confuse them — the platform should refuse a type-2 NPI in the individual provider field, but verify.
• Taxonomy mismatches kill claims silently. If the provider's NPPES taxonomy says "Psychiatry" but you set "Psychologist" in Credentik, every claim you bill will have a mismatch in the 837 vs payer credentialing record. Result: denials with no clear reason. Sync to NPPES exactly.

Related jobs

• Work an application from intake to credentialed — the next thing after the provider exists
• Run PSV — required compliance check
• Renew a license — the ongoing chore for each license you just added

Something on this page doesn’t match what you see in the app? Email support@credentik.com and we’ll fix the guide.