See your providers' credentialing status

For: Practice Admin · Time: 5 min · Frequency: Weekly check; ad-hoc when hiring or onboarding payers

Trigger

Hiring a new provider OR a payer is asking why claims for one of your providers are denying OR you want to know "can Dr. X bill Aetna yet?"

Outcome

You know which providers are in-network with which payers, what's in progress, and what hasn't been started. You can tell a patient or a payer the truth.

Where

• Applications
• Providers — provider list
• Provider Detail → Applications tab

Steps

1. The big-picture view: Applications page. See every application your agency has filed for your providers. Filter by status (credentialed = in network).
2. Per-provider view: Providers → click provider → Applications tab. Shows that one provider's enrollment status with every payer.
3. Per-payer view: Applications → filter by payer name. Shows every provider's status with that payer (e.g. "all my Aetna applications").
4. Status meanings:
   • Draft — agency is preparing the application.
   • Ready to Submit — packet complete, awaiting submission.
   • Submitted — sent to payer.
   • In Review — payer received and is reviewing.
   • Pending Info — payer asked for more info (agency is handling).
   • Approved — payer approved but contract not signed yet.
   • Credentialed — fully in-network, can bill.
   • Denied / Withdrawn — application terminated.
5. For a specific application, click into the detail to see:
   • Timeline of status changes
   • Notes from the credentialing coordinator
   • Followup dates (when agency expects to chase the payer next)
   • Effective date (once credentialed)

Watch-outs

• "Credentialed" doesn't always mean "can bill immediately." Some payers backdate effective dates; some only let you bill from approval date forward. Look at the effective date, not just status.
• A provider can be credentialed with payer X but not payer X's specific product. E.g. credentialed with Aetna Commercial but not Aetna Medicare Advantage. They're separate applications. Check ALL.
• Recredentialing is on a clock. Most payers recredential every 24–36 months. The agency tracks this; you should see future-dated reviews on the applications list. If you don't see one for a provider who's been credentialed >2 years, ask the agency.
• Don't bill before credentialed. It's tempting when a provider starts, but billing under another provider's NPI (a "borrowed" billing arrangement) is fraud unless explicitly allowed by the payer contract (rare exception: incident-to billing under Medicare with strict rules). Just wait.

Related jobs

• Check claim status — when a claim denies and you suspect credentialing
• Agency Owner → Payer strategy — for context on what your agency chose to credential and why

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