Your new provider can't bill yet. Here's why, and what actually helps.

• Start date is coming and we have not submitted anything→ Timelines
• They have started and cannot bill→ The cost
• We submitted months ago and nothing is moving→ Why it is slow
• The payer says the panel is closed→ Closed panel

Pick the closest and jump straight to it. Each section stands alone.

Knowing which one you are waiting on tells you whether escalation will help or whether you are simply in a queue.

The four processes

The pieces that feed all of it

NPI and taxonomy. Issued through NPPES. Everything downstream depends on it, and mismatches between NPPES, CAQH and the application are a leading cause of development letters. Match them exactly, including punctuation in the practice name.

CAQH (now DataSpring, powered by CAQH). Most commercial payers pull application data from the provider's profile rather than a separate form. Attestation is required every 120 days and a lapsed profile stalls applications silently. See Section 5 for what changed in 2026.

Medicare

Enrolment runs through PECOS, the electronic version of the CMS-855 forms.

For a new provider joining your group you generally need both an 855I and an 855R, and the 855R cannot process until the 855I is approved. That sequence is invisible until it delays you.

Realistic Medicare timelines: CMS targets around 15 days for a clean electronic application, but actual processing commonly runs 45 to 90 days and longer during peak periods. Roughly a third of applications come back for correction, and a development letter pauses the clock rather than running alongside it.

PECOS 2.0 and why small data mismatches now stop you. PECOS 2.0 is the system of record in 2026, with migration completing through the year. It runs real-time validation against IRS and NPPES records and requires multi-factor authentication through CMS Identity and Access Management.

The practical consequence is that trivial formatting differences now trigger a Stay of Enrollment hold on an otherwise clean file. "Suite 204" against "Ste 204" is enough. Before filing anything, put your IRS letter, your NPPES record and your application side by side and match them character for character, including punctuation and abbreviations.

Medicaid

No single process. Every state runs its own, from around 30 days in streamlined states to 180 or more elsewhere.

The part practices miss: in managed care states, enrolling with the state fee-for-service programme is not enough. The provider must also credential separately with each Medicaid managed care organisation. In a state with five MCOs that is six applications. As of 2024 data, 78 percent of Medicaid beneficiaries were in comprehensive managed care organisations, per KFF, so state enrolment alone reaches less than a quarter of the Medicaid population.

Commercial

Credentialing review then contracting, as separate steps. Typically 90 to 120 days for the review, 90 to 180 in saturated markets, plus 30 to 45 days for contracting and loading.

Delegated credentialing

A payer can delegate credentialing to a group that meets NCQA standards, letting it credential its own providers and skip the payer queue. It compresses onboarding significantly, and it requires NCQA-compliant verification, a credentialing committee, ongoing sanctions monitoring and a pre-delegation audit. Standing one up is roughly a year to eighteen months of work. Realistic for a large group, not for a three-provider practice.

Re-credentialing

None of this is once and done. NCQA requires re-credentialing at least every 36 months. Medicare requires revalidation every five years. CAQH / DataSpring requires attestation every 120 days. Miss a revalidation and privileges deactivate, with reactivation taking 60 to 90 days and no retroactive billing for the gap.

Nothing operational changed for providers. Same portal, same login, same data, same 120-day attestation cycle. Most published guidance still describes the previous arrangement, which is worth knowing when you read older advice.

Confirmed facts

• ●January 2026: CAQH announced ownership by twelve shareholder companies affiliated with leading health plans, converting from a not-for-profit.
• ●8 June 2026: rebranded as DataSpring, powered by CAQH, announced at AHIP 2026.
• ●ProView is now the CAQH Provider Data Portal. The URL, logins, profile data, documents, payer authorisations and attestation history all carried over.
• ●Named shareholders reported include UnitedHealth Group, Centene, Aetna, Elevance Health, Cigna, Humana and Blue Cross Blue Shield plans.
• ●The platform holds more than 4.8 million provider records and connects eligibility information for more than 75 percent of US covered lives.

Unchanged

• ●Attestation is still every 120 days.
• ●The enter-once-share-with-many model is intact.
• ●It remains free to providers.
• ●No one needs to re-register or rebuild a profile.

Some commentators have argued that payers owning the platform that verifies credentials may reduce tolerance for data inaccuracies. That is analysis, not an announced policy change. We are flagging it as such rather than repeating it as fact.

What is still worth doing: treat the 120-day attestation as a standing recurring task, and make sure the reminder email on file is yours rather than a former vendor's.

Add the collections you cannot bill, then subtract what is genuinely recoverable. The result is defensible. The figures circulating online are not.

The method

1. 1Daily compensation cost — Salary plus benefits plus employer taxes, divided by working days. This is running whether or not anyone can bill.
2. 2Allocated overhead — Space, support staff, malpractice, equipment. Also running.
3. 3Forgone net collections — Expected weekly encounters times payer mix times your own average net collection per encounter. Use net, not gross charges, and use your own historical figure for that specialty.
4. 4Subtract what is recoverable — Self-pay patients seen, payers where the provider is already loaded, and any payer that has confirmed a retroactive effective date in writing. Section 9 covers what that actually amounts to.

About the numbers you will find elsewhere

You will encounter three figures repeatedly. All three come from companies that sell credentialing services.

• The $122,144 per provider figure originates with a credentialing software company, calculated against Bureau of Labor Statistics salary data. The BLS input is a censored median, meaning BLS reports that physician median pay equals or exceeds $239,200 without publishing a precise figure above it. The estimate is built on a floor value.

• The $7,500 per day and $9,000 per day figures appear across dozens of vendor blogs, usually attributed to "industry research" with no traceable source. We could not trace either to any independent study.

We are not going to repeat them. Your own number will be more useful and you can defend it in a partners' meeting.

Use the planner in Section 7 below to work out your own exposure from your own figures.

Never hold claims on an assumed backdate you have not confirmed in writing.

Medicare

Under 42 CFR 424.521, retrospective billing is permitted for up to 30 days before the effective date where circumstances prevented earlier enrolment. Ninety days only where a Presidentially declared disaster prevented it.

The effective date itself is the later of the date the approved application was filed, or the date the provider began furnishing services at the location. So the 30 days runs backwards from filing, not approval.

The same 30-day rule applies to reassignments filed on the 855R.

Commercial

No statute governs this. It is per payer and per contract. Some allow retroactivity to the submission date, often capped. Many have narrowed or removed it entirely, and a payer can change its position between one hire and the next without announcing it. If a payer will grant a retroactive effective date, get it in writing before you hold a single claim.

Held claims and timely filing

Practices commonly hold claims during credentialing and submit once the provider is loaded. The binding constraint is timely filing, not credentialing status. Medicare allows 12 months from date of service. Commercial windows can be as short as 90 days. If the gap plus the hold exceeds the filing window, the money is gone regardless of merit.

Where retroactive enrolment is later approved, some payers will restart the filing clock from the retroactive effective date, and a timely filing denial can occasionally be appealed with the credentialing approval letter attached. Do not plan around this without written confirmation.

Note: this section requires legal and compliance review before publication.

No vendor can make a payer's credentialing committee meet sooner. Nothing makes a committee sit sooner.

Highest impact

1. 1Start the day the offer is signed, not the start date. A 90-day payer timeline that begins 30 days into your process leaves 60 days of overlap rather than 90 days of an unbillable salary.
2. 2Confirm panel status before agreeing the start date. One call to provider relations per key payer.
3. 3Keep CAQH / DataSpring current all year and authorise the payers. Not an onboarding task, a standing one.
4. 4Submit every payer in parallel. Medicare, Medicaid, each MCO and each commercial payer run on separate tracks.
5. 5Clean the data before submitting anything. NPPES, CAQH / DataSpring and the IRS letter matching exactly.

Escalation that works

6. 6Document every submission date, call, reference number and name. This is your evidence if an application goes missing.
7. 7Escalate after the stated turnaround with your documented history. Ask for a supervisor once past the payer's own published timeframe.
8. 8Involve the provider relations representative. The relationship contact can often locate a stalled file or confirm a queue position.

Outside your control

• ●Payer queue depth.
• ●Contractor processing time.
• ●How often the credentialing committee meets.
• ●State licence issuance.
• ●Whether a commercial payer grants retroactivity.

Managing the gap

Schedule the provider for payers where they are already loaded, and for self-pay patients. Use the remaining time for chart preparation, protocol work and integration rather than idle days. Some practices structure a later billable start date in the offer — worth considering at negotiation rather than discovering afterwards.

A new tax ID is a new entity to every payer, which means starting over rather than amending. A new location is a reportable change with its own 30-day clock and its own claims-system loading.

New provider joining an existing group

The straightforward case. For Medicare, an 855I if the provider is not already enrolled, plus an 855R reassigning billing rights to the group. The 855R cannot process until the 855I is approved.

Worth knowing on the way out as well as in: when a provider leaves, the reassignment has to be terminated, or claims keep flowing to your tax ID under their number. The Office of Inspector General has settled with physicians who failed to monitor what was billed under their reassigned numbers.

New tax ID

A new EIN makes you a new provider to Medicare and to commercial payers. You cannot amend a tax ID on an existing enrolment. This catches practices restructuring from a sole proprietorship to an LLC, where the tax classification and EIN change and the enrolment restarts from scratch.

If a restructure is being discussed, get the enrolment consequences on the table before the accountant finalises anything. The tax advantage may be smaller than the billing gap.

Buying or selling a practice

Whether billing continues uninterrupted depends on how the transaction is structured. In a change of ownership under 42 CFR 489.18, the seller's Medicare identification number and provider agreement transfer to the buyer if the buyer accepts the agreement, along with any outstanding Medicare debt. If the buyer does not accept it, the agreement terminates and the buyer is a new applicant with a new enrolment timeline.

An acquisition or merger is different again, and a stock transfer is generally not a change of ownership at all but a change of information. Establish which of these you are doing early, because the answer determines whether you keep billing on day one or start over.

Second location

A reportable change, generally within 30 days. CMS may require the new location to be enrolled separately, and every commercial payer has to load the new service address.

This is a frequent and quietly expensive cause of denials, because claims from an unregistered location deny while everything else about the provider is correct. If denials start after you open a room down the road, look here first.

But the audit is useful even if credentialing is all you need, because it shows what is sitting unbilled, what is close to a filing deadline, and whether anything else is contributing. No obligation, and no requirement to change anything.