CREDENTIALING REVIEWS - CREDENTIALING CHECKLIST
Updated October 8, 2026
Operated by Alevated Holdings LLC.
A planning aid. Requirements vary by payer, state, provider type and facility. Tick completed items or mark N/A with a reason.
PROJECT / OWNER / REVIEW DATE: __________________________

DEFINE THE WORK
[ ] Scope and owner. List provider types, entities, locations, states and target payers; assign an internal owner.
[ ] Application path. Get each payer or facility's current checklist; confirm initial, update, recredentialing or revalidation work.
[ ] Responsibilities. Identify who supplies records, submits applications, answers requests and checks the final outcome.

RECONCILE THE IDENTIFYING INFORMATION
[ ] Provider and entity details. Check legal names, addresses, tax details and NPIs against the applicable records. Keep sensitive numbers off this worksheet.
[ ] NPI type. Confirm individual versus organizational requirements. CMS treats a sole proprietorship as Type 1; do not assume every practice needs both types. [1]
[ ] Practice changes. Flag new clinicians, locations, ownership or entity changes; ask the payer which updates or applications apply.

PREPARE THE SUPPORTING RECORDS
[ ] Qualifications. Gather the current CV/work history, education, training, licenses and certifications requested by the reviewing organization.
[ ] Conditional documents. Confirm requirements for liability coverage, references, affiliations, disclosures and DEA or other registrations where applicable.
[ ] Data consistency. Resolve missing dates, name differences and expired documents before submission; retain the approved versions.

CHECK SHARED PROFILES AND ACCESS
[ ] CAQH, where used. Review profile data and supporting documents, authorize relevant organizations and complete required attestations. Use current portal instructions. [2]
[ ] Program access. For Medicare, confirm the correct enrollment path and authorized PECOS access. An NPI is not proof of enrollment. [3]
[ ] Secure handover. Use the designated secure channel for records. Do not place patient details, passwords or confidential documents in this checklist.

TRACK EACH APPLICATION
[ ] Submission evidence. Save the submitted version, receipt or reference, date, and the payer/facility contact route.
[ ] Follow-up. Record the latest request, responsible person and next follow-up date. Keep estimates separate from confirmed dates.
[ ] Exceptions. Resolve missing information and record responses; ask about closed panels or eligibility before treating a delay as administrative.

CONFIRM COMPLETION AND MAINTAIN IT
[ ] Written outcome. Retain approval or enrollment evidence, participation terms and any applicable effective date; submission alone is not completion.
[ ] Team handoff. Give billing and scheduling staff the confirmed provider, payer, entity and location scope. Resolve uncertain start dates before relying on them.
[ ] Maintenance. Assign owners for license/insurance expirations, CAQH attestations, payer updates and program revalidation. Record each applicable due date.

NEXT ACTION LOG
Provider / payer / location reference:
Status / evidence:
Next action / owner / due date:

PRIMARY SOURCES (checked October 8, 2026)
[1] CMS NPI instructions: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10114.pdf
[2] CAQH provider guide: https://www.caqh.org/sites/default/files/solutions/proview/guide/provider-user-guide.pdf
[3] CMS enrollment: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/EnrollmentResources/provider-resources/provider-enrolment/Med-Prov-Enroll-MLN9658742.html

Compare services and software: https://credentialingreviews.com/compare/
Do not include patient details, passwords or confidential documents in this worksheet.