Credentialing New Providers Post-Certification: How to Onboard Before Full Enrollment

Bringing a new provider into your practice is an exciting milestone, but it also comes with administrative hurdles that, if not handled correctly, can delay revenue and compromise compliance. One of the biggest challenges? Credentialing and onboarding a provider before full payer enrollment is completed.

This blog explains how medical practices, hospitals, and group facilities can streamline the process of onboarding newly certified providers—without waiting weeks (or even months) for full credentialing approval. By following a strategic approach, you can ensure regulatory compliance, optimize revenue capture, and set your provider up for success from day one.

What is Credentialing and Why Does It Matter?

Credentialing is the process of verifying a healthcare provider’s qualifications, including education, training, licensure, and work history. This process is crucial for:

• Payer enrollment (Medicare, Medicaid, commercial plans)
• Hospital privileges
• Liability protection
• Compliance with accreditation bodies (e.g., NCQA, The Joint Commission)

Failure to properly credential a provider can result in denied claims, delayed reimbursements, and potential legal exposure.

Common Credentialing Timeline Challenges

The credentialing process can be notoriously slow, with average approval times ranging from 60 to 120 days, depending on the payer. During this period:

• Providers may be clinically active, but not yet billable.
• Payers may backdate enrollment (rarely guaranteed).
• Practices may face lost revenue or complex retroactive billing scenarios.

This lag between certification and full enrollment poses operational and financial risks. That’s why a proactive onboarding strategy is essential.

Pre-Credentialing Checklist: What to Do Immediately After Certification

Before initiating full enrollment, ensure the following are ready:

     1.National Provider Identifier (NPI) Application

• • Apply for a Type 1 NPI as soon as the provider receives their license.
  • Use the NPPES portal for fast processing.

     2.CAQH Profile Completion

• • Most commercial payers pull data from CAQH ProView.
  • The provider must create and attest to their CAQH profile for accurate credentialing.

     3.Licensure and DEA Registration

• • Confirm all state licenses, DEA, and state-controlled substance registrations are active and uploaded.

     4.Collect Documentation

• • CV (in month/year format)
  • Board certifications
  • Malpractice insurance (with adequate coverage limits)
  • Hospital privileges (or plan for temporary admitting privileges)

How to Onboard Before Full Enrollment: Best Practices

While waiting for credentialing approval, practices can onboard providers strategically using the following approaches:

     1.Use Locum Tenens or Substitute Billing (When Permissible)

Some payers, including Medicare, allow the use of locum tenens billing (modifier Q6) for up to 60 consecutive days under a supervising physician’s NPI.

Requirements:

• Temporary absence of a credentialed provider (e.g., vacation, leave)
• Substitute provider is properly licensed
• Billed under the supervising physician’s NPI using modifier Q6

Caution: This is not a long-term solution, and commercial plans vary in acceptance.

     2.Incident-To Billing (For NPPs)

For non-physician practitioners (NPPs) such as nurse practitioners or physician assistants, incident-to billing may allow billing under a supervising physician until full credentialing is completed.

Conditions:

• Services must be part of the physician’s plan of care
• The physician must be present in the office suite
• Only certain services are eligible
• Must follow payer-specific rules

     3.Cash-Pay Services During the Interim Period

Some practices opt to provide services on a cash-pay basis while waiting for credentialing.

Guidelines:

• Inform the patient in writing that insurance will not be billed
• Offer a discount or payment plan if needed
• Do not attempt retroactive billing unless permitted by the payer

This is especially useful in concierge or direct primary care settings.

     4.Billing Retroactively (Only When Allowed)

Some payers allow retroactive billing once a provider is fully credentialed, with backdating to the application date.

Tip:

• Keep comprehensive documentation of services provided
• Store encounters in your EHR with proper coding
• Submit claims as soon as the effective date is confirmed

Always confirm with each payer before delivering care under this assumption.

     5.Supervised Clinical Activity (Non-Billable Work)

While waiting for full enrollment, new providers can still:

• Perform chart reviews
• Conduct telehealth follow-ups under supervision
• Assist with care coordination and patient education
• Shadow other providers

These activities, while non-billable, support continuity of care and acclimate the provider to your workflow.

Set Up a Credentialing Tracker

A centralized credentialing dashboard helps track every step of the process:

Assign a dedicated credentialing coordinator or outsource to a credentialing service to maintain accuracy and ensure follow-ups.

Common Credentialing Mistakes to Avoid

• Starting enrollment late: Begin the credentialing process at least 90–120 days in advance of the planned start date.
• Incomplete CAQH or application errors
• Missing documents (e.g., malpractice insurance, transcripts)
• Not following up with payers regularly
• Billing prematurely or under the wrong NPI

Tools and Resources for Credentialing Success

• CAQH ProView for commercial payers
• PECOS for Medicare enrollment
• Availity and payer portals for real-time status updates
• Credentialing software (VerityStream, MedTrainer, Modio) to centralize documentation

Outsourcing to an experienced medical billing and credentialing company can also reduce errors and speed up onboarding.

Conclusion

Credentialing is a time-consuming but non-negotiable part of bringing new providers into your organization. By preparing early and using strategic billing workarounds like locum tenens or incident-to billing where allowed, you can begin onboarding before full payer enrollment without sacrificing compliance or revenue.

Whether you’re managing a solo practice or a multi-specialty group, the key is to create a repeatable, transparent, and well-documented credentialing process. This ensures your providers can hit the ground running—and get paid for it—starting from day one.