Start here, the federal and shared systems
The order of operations
1
NPPES
Type 2 NPI for the PC (requires the EIN); confirm each clinician’s existing Type 1.
2
CAQH
Build or update the profile, upload documents, authorize every target payer, attest.
3
PECOS
Medicare 855B, 855I per clinician, 855R reassignment, 588 for EFT.
4
State Medicaid
Agency enrollment, plus every managed care plan in your service area.
5
Commercial payers
Contract, then credential, then EDI/ERA/EFT.
National commercial payers
Blue Cross Blue Shield
“BCBS” is roughly thirty independent licensee companies. A contract with one is not a contract with another. Enroll with the Blue licensee for your state. Find yours through the BCBS Association plan finder, then go to that company’s own provider site. BlueCard lets you bill your local Blue for an out-of-area Blue member — it handles travelling patients, not network participation where you have an office.Government programs
State Medicaid index
Each state runs its own enrollment portal. The reliable route:1
Start at Medicaid.gov's state overview
medicaid.gov/state-overviews links to each state agency.
2
Find the state's provider enrollment portal
Naming varies enormously, “provider enrollment,” “provider services,” or a vendor-branded portal.
3
Identify every MCO in your service area
State agency enrollment is necessary but rarely sufficient. Most Medicaid beneficiaries are in managed care plans, and each MCO requires its own contract and credentialing. A state with five MCOs is six enrollments. See Enroll in state Medicaid.
Dental payers
🦷 Dental credentialing is separate from medical, even at the same brand. A group operating both medical and dental entities runs two largely disjoint payer operations.
Vision plans
👁 Vision plans are separate from medical, with separate credentialing and frequently their own submission channels rather than standard clearinghouse routing. See Optometry and vision.
Behavioral health carve-outs
Many medical plans carve behavioral health out to a separate administrator requiring separate contracting and credentialing:🧠 Contracting with a medical plan does not get you into its behavioral network. Check for a carve-out on every payer. See Behavioral health.
Clearinghouse payer lists, the canonical source for IDs
Payer IDs are clearinghouse-specific, and professional and institutional claims can have different IDs for the same payer. Always use your clearinghouse’s list.