Key takeaways
- Enrollment needs ongoing maintenance: CAQH, re credentialing, revalidation, and renewals.
- A missed deadline can stop payments weeks before anyone notices.
- Track every provider, payer, and expiring item in one place.
Once a provider is enrolled, it is easy to assume the work is done. It is not. Payers re check providers on a cycle, Medicare requires revalidation, CAQH needs regular attestation, and licenses and insurance expire. Any one of these can interrupt payments if it is missed.
The recurring deadlines to track
- CAQH ProView attestation, every 120 days in most states.
- Payer re credentialing, often every two to three years depending on the payer.
- Medicare revalidation, generally every five years for most providers, with CMS able to request it off cycle.
- State Medicaid revalidation, on the state's schedule.
- State license renewal.
- DEA registration renewal, where applicable.
- Board certification and malpractice insurance renewal.
What happens when something lapses
When a CAQH attestation lapses, payers cannot use the profile. When a Medicare revalidation is missed, billing privileges can be deactivated, and claims for services during the gap may not be payable. When a payer's re credentialing request goes unanswered, the provider can be removed from the network. These problems often show up first as denials, weeks after the deadline passed.
How to stay ahead
- Keep one list of every provider, every payer, and every expiring item, with due dates.
- Set reminders well before each due date, not on it.
- Check the CMS revalidation list for Medicare due dates, which CMS posts in advance.
- Update CAQH whenever something changes, such as a new location or a renewed license, then attest.
- Watch for payer letters and portal messages asking for re credentialing information, and answer quickly.
- Report changes, such as address or ownership changes, to Medicare and other payers within their required timeframes.
Changes that need reporting
Moving locations, adding a practice site, changing ownership, changing the tax ID, or a provider leaving the group all need to be reported to payers. Each payer has its own process and timeframe. Missing a change can cause claims to deny or payments to go to the wrong place.
Keep copies of every renewal and attestation confirmation. When a payer questions a date, proof saves time.
A quick example
A provider renews her license and malpractice policy on time, but nobody updates CAQH. At her next attestation the profile shows expired documents, and a payer's re credentialing review stalls. Updating CAQH the day a renewal arrives, then attesting, would have kept the review moving.
Questions to ask your team
- Who tracks expiring documents for each provider?
- When is each provider's next CAQH attestation and Medicare revalidation?
- How are payer re credentialing letters routed and answered?
Build a simple tracker
A tracker does not need special software. A shared sheet with one row per provider and payer, plus columns for CAQH attestation date, license expiry, malpractice expiry, Medicare revalidation date, and next re credentialing date, covers most practices. Sort it by the next due date each week and assign each item to a named person.
Where Afiable helps
Afiable tracks expirations, CAQH attestations, re credentialing, and revalidation dates for each provider and payer, and handles the paperwork before deadlines. Book a free audit and we will review your enrollment status and flag anything coming due.
Questions practices ask
How do I find my Medicare revalidation date?
CMS publishes revalidation due dates in advance on its revalidation list, and Medicare contractors send notices before the due date.
Does re credentialing require a new application?
Usually it is shorter than the first application, but payers ask for updated information and documents. Answer requests quickly to avoid network removal.
This article is general information for practice owners and managers. Payer policies and regulations change, so confirm current rules with each payer before acting.