> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Credential each new provider you hire

> The repeatable per-hire pipeline: primary source verification, CAQH, payer-by-payer linkage, the tracking grid, and staffing strategies for the 90–150 day gap.

Every clinician you hire must be credentialed with **every payer**, and linked to **each PC's** group contract. Contracting happens once per payer per group; credentialing happens once per payer per clinician. This is the repeatable pipeline.

## Prerequisites

* The group already contracted with the payers
* A credentialing tracking grid
* The new clinician's documents assembled

## The per-hire pipeline

<Steps>
  <Step title="Start at offer acceptance, not at start date">
    Credentialing takes 90–180 days. Starting when the clinician arrives means three to six months of a salaried clinician who cannot bill.

    Kick off the moment the offer is accepted and the licensure path is clear.
  </Step>

  <Step title="Collect the document packet">
    * Current state license(s)
    * DEA registration and state controlled substance registration where applicable
    * Board certification
    * Medical school and residency/fellowship documentation
    * Malpractice certificate of insurance and claims history
    * **Complete work history with no unexplained gaps**
    * CV in the format payers accept
    * Government ID, SSN
    * Type 1 NPI
    * Hospital privileges, or the admitting arrangement if none
  </Step>

  <Step title="Run primary source verification and screening">
    | Check                            | Source                                   |
    | -------------------------------- | ---------------------------------------- |
    | License, active and unrestricted | State board's own verification           |
    | Disciplinary history             | State board, every state held            |
    | **OIG exclusion**                | [LEIE](https://exclusions.oig.hhs.gov/)  |
    | **Federal debarment**            | [SAM.gov](https://sam.gov/)              |
    | State Medicaid exclusion         | State list                               |
    | Malpractice history              | NPDB self-query, carrier loss run        |
    | Education and training           | Primary source or a verification service |
    | Medicare enrollment / opt-out    | PECOS                                    |

    Document each with a date. Re-run exclusion checks **monthly** thereafter.
  </Step>

  <Step title="Set up or update CAQH">
    New profile if they genuinely don't have one; otherwise update the existing profile with your practice location and re-attest.

    **Authorize every payer** you'll submit to. An unauthorized payer cannot retrieve the profile and the application waits.
  </Step>

  <Step title="Submit to every payer, in parallel">
    Not sequentially. All applications go out in the same week.

    For each payer: link the clinician to the **group's existing contract** rather than initiating a new contract. This is a different (and faster) process than group contracting.
  </Step>

  <Step title="Submit Medicare 855I and 855R">
    Individual enrollment plus reassignment of benefits to the group. Without the 855R the group cannot bill for their services.
  </Step>

  <Step title="Submit Medicaid and each MCO">
    Per state, per plan.
  </Step>

  <Step title="Track and follow up every two weeks">
    Applications go quiet rather than getting denied. Log every contact.
  </Step>

  <Step title="Record every effective date">
    You cannot bill for services before the **later** of the group contract effective date and this clinician's provider effective date, for that payer.
  </Step>

  <Step title="Enter the recredentialing date on the compliance calendar">
    Typically a three-year cycle per commercial payer.
  </Step>
</Steps>

## The tracking grid

At two clinicians and three payers a spreadsheet is fine. At twenty clinicians, ten payers, and five entities you are tracking a thousand rows and credentialing software earns its cost.

Columns you need:

| Column                          |
| ------------------------------- |
| Entity (which PC)               |
| Tax ID                          |
| Group NPI                       |
| Clinician                       |
| Individual NPI                  |
| Payer                           |
| Application submitted date      |
| Last follow-up date and contact |
| Status                          |
| **Provider effective date**     |
| Recredentialing due date        |
| CAQH attestation date           |
| Notes                           |

## Managing the 90–150 day gap

A salaried clinician who cannot bill is expensive. The options, with their limits:

| Option                                                                                | Viability                                                 |
| ------------------------------------------------------------------------------------- | --------------------------------------------------------- |
| **Start them on non-billable work**, training, protocol development, quality projects | Always safe                                               |
| **Hold claims** until the effective date, then submit                                 | Safe if within timely filing; check each payer's limit    |
| **Retro-effective dates**                                                             | Ask in writing at application; some payers grant          |
| **Schedule them with payers where they're already credentialed**                      | Requires payer mix flexibility                            |
| **Cash-pay or self-pay patients**                                                     | Safe, with a good faith estimate                          |
| **Locum tenens billing (Q5/Q6 modifiers)**                                            | Narrow rules; specific circumstances only                 |
| **"Incident-to" billing**                                                             | **Narrow Medicare-specific rules; frequently misapplied** |

<Warning>
  **Do not bill a credentialed clinician's NPI for services another clinician performed.** This is the shortcut people reach for, and it is false claims exposure, not a billing irregularity. Incident-to and locum tenens have specific, narrow requirements, and neither is a general workaround for uncredentialed providers. See [Handle credentialing delays and gaps](/guides/enrollment/handle-credentialing-delays).
</Warning>

## Verify it worked

* [ ] Pipeline started at offer acceptance
* [ ] Full document packet collected
* [ ] Primary source verification complete and dated
* [ ] OIG LEIE and SAM.gov clear, documented
* [ ] CAQH complete, all payers authorized, attested
* [ ] Applications submitted to every payer in parallel
* [ ] Medicare 855I and 855R submitted
* [ ] Medicaid and every MCO submitted
* [ ] Follow-up log maintained
* [ ] Every effective date recorded
* [ ] Recredentialing dates calendared
* [ ] Monthly exclusion re-screening in place

## Common failure modes

| Failure                                               | Consequence                             |
| ----------------------------------------------------- | --------------------------------------- |
| Starting at start date, not offer acceptance          | 3–6 months of unbillable salary         |
| Sequential rather than parallel submissions           | Months added                            |
| Payer not authorized in CAQH                          | Application waits indefinitely          |
| 855R never filed                                      | Medicare cannot pay the group           |
| Scheduling insured patients before the effective date | Unbillable services                     |
| Billing under a different clinician's NPI             | False claims exposure                   |
| No recredentialing tracking                           | Silent termination three years later    |
| Exclusion screening only at hire                      | An exclusion after hire goes undetected |


## Related topics

- [Set up and maintain CAQH profiles](/guides/enrollment/set-up-caqh.md)
- [Handle credentialing delays and gaps](/guides/enrollment/handle-credentialing-delays.md)
- [Track licenses, revalidations, and expirables](/guides/enrollment/maintain-revalidations.md)
- [Claim denials, explained](/concepts/payments/claim-denials.md)
- [Billing compliance: the lines you never cross](/concepts/compliance/billing-compliance-basics.md)
- [Payer enrollment & submission links](/reference/payers/enrollment-links.md)