5 Steps to Ensure a Smooth Recredentialing Process

Recredentialing is an important process that helps maintain accurate provider information and supports compliance with accreditation and regulatory requirements. Taking a few proactive steps throughout the year can help avoid unnecessary delays and reduce administrative burden when it is time to recredential.

1. Maintain Current Professional Liability Coverage

Professional liability (malpractice) insurance is a required component of the credentialing and recredentialing process. Providers should routinely verify that coverage remains active and meets applicable participation requirements.

Before your recredentialing cycle begins, ensure:

• • Coverage is active and not approaching expiration.
  • Coverage meets minimum network requirements.
  • Any changes in carrier, policy number, or coverage limits have been updated in the Council for Affordable Quality Healthcare (CAQH) portal and communicated to the health plan when applicable.
  • Current certificates of insurance are readily available.

2. Keep Work History and Professional Information Up-to-Date

Accurate professional history allows credentialing staff to verify training, employment, and clinical experience efficiently. Providers should review their curriculum vitae (CV) and the CAQH profile regularly to ensure information is complete and current.

Be sure to:

• • Include all current and prior practice affiliations.
  • Update employment and practice dates as changes occur.
  • Account for any gaps in professional activity according to credentialing requirements.
  • Verify practice locations, hospital affiliations, and professional titles.

Maintaining an updated work history throughout the year is much easier than reconstructing several years of information during recredentialing.

3. Review Licensure, DEA, and Certification Status

Providers are responsible for maintaining current professional licenses, registrations, and certifications applicable to their scope of practice.

Consider creating reminders for upcoming expiration dates, including:

• • State professional licenses.
  • DEA registrations and Controlled Substance registrations required by state law (when applicable).
  • Board certifications.
  • National Plan and Provider Enumeration System (NPPES).

Promptly updating these items in CAQH and other credentialing systems helps ensure that primary source verification can be completed without unnecessary follow-up.

4. Verify Practice Demographic Information

Accurate provider directory information benefits both patients and participating providers. Incorrect demographic information can affect patient access, referral patterns, and communication from the health plan.

Take time to review:

• • Practice addresses.
  • Telephone and fax numbers.
  • Office hours.
  • Accepting New Patients status.
  • Telehealth availability.
  • Languages spoken by providers and staff.
  • Hospital affiliations and practice ownership information.

Regular reviews help ensure members can locate and access care without difficulty.

5. Respond Promptly to Credentialing Requests

Even when most information is available electronically, health plans may occasionally require additional documentation or clarification to complete the credentialing review.

If you receive a request for information:

• • Respond as soon as possible.
  • Submit complete documentation whenever possible.
  • Monitor email and fax communications from credentialing staff.
  • Notify the health plan if key contacts within your office change.
  • Designate a credentialing contact within your practice to facilitate communication.

Timely responses can significantly reduce processing times and help prevent delays in credentialing and recredentialing decisions.

A Friendly Reminder

One of the best ways to prepare for recredentialing is to keep your CAQH profile current throughout the year and ensure global authorization is set. Regularly updating your professional information and completing timely attestations can streamline the review process and minimize the need for follow-up requests from credentialing staff.

By taking these simple steps now, providers can help ensure a smoother, more efficient recredentialing experience when their next review cycle arrives.

Please email credentialing@htanc.com with any questions or concerns.