Part 2: Before You Apply – What to Gather First
🕒 Updated on Last Modified Date
Welcome back to the Credentialing Series.
In Part 1, we talked about what credentialing is, why it matters, and how it fits into the bigger picture of building an insurance-friendly private practice. Now it is time for the very unglamorous but very important part of the process: getting organized.
Before you fill out a single application or reach out to any insurance company, there is one key step that will either make or break your experience:
Gather your documents and details ahead of time.
When this step is skipped, providers often find themselves stuck in an endless loop of emails, requests for “one more document,” and frustrating delays. When it is done well, the process feels calmer, more predictable, and honestly, a lot less overwhelming.
Think of this as building your credentialing toolkit. Once it is set up, you can reuse it every time you apply to a new panel or need to re-credential in the future.
Why This Step Matters
Most insurance companies use similar applications, especially when they pull information from CAQH, but each payer still has its own checklist and its own quirks. If one date is off, a license is expired, or your name appears differently in two places, your application can be delayed or even denied.
When everything is complete, clear, and consistent:
- Payers can verify you more quickly
- You spend less time digging through old emails and portals
- You look organized and professional, which always helps when you need to follow up later
This is one of those “slow down to speed up” tasks. It may take an hour or two to gather everything, but it can save you weeks of back and forth.
What to Gather Before You Apply
Here is what you should have ready before submitting any credentialing paperwork.
1. NPI Number
Your National Provider Identifier is required for every credentialing application. Most providers will already have an NPI, but if you are new to practice you may need to apply for one.
Make sure you know:
- Your individual NPI (Type 1)
- Your group NPI (Type 2), if you will bill through a business entity
Keep a PDF or screenshot of your NPI confirmation in your credentialing folder.
2. State License(s)
You must be licensed in the state or states where you plan to provide services. Payers will check this closely.
Confirm that:
- Your license is active and not close to expiring
- Your name and credentials appear exactly the same here as on your NPI and other documents
- You have a clear PDF copy saved
If you hold licenses in multiple states, keep them all in one place and label them clearly. This matters especially for telehealth or multi-state practices.
3. Malpractice Insurance Certificate
Insurance companies want to know that you and their members are protected.
Most payers look for:
- Coverage limits of at least 1 million / 3 million
- Current effective and expiration dates
- Your name or business name listed correctly
Download the full declaration page from your malpractice carrier and save it in your credentialing folder. If your policy is about to renew, it is better to wait for the updated certificate than to send something that will expire mid process.
4. W-9 Form
Your W-9 tells payers who they are contracting with and how they will report payments for tax purposes.
Double check that:
- The legal name and tax ID match your business structure
- The address matches what you plan to use on applications
- You are using the correct EIN or SSN for your situation
If you change your address or legal business name later, remember that the W-9 and your payer records will need to be updated too.
5. Resume or CV
Your resume or CV is not just a formality. Payers use it to verify training, experience, and employment history.
Make sure it:
- Includes all relevant work history and clinical roles
- Accounts for gaps longer than 6 months whenever possible
- Lists internships, fellowships, and supervision if they are relevant to your specialty
If you took time off for family, health, or relocation, that is completely normal. Just be ready to briefly explain long gaps if a payer asks.
6. CAQH Profile
For most commercial plans, CAQH is the central hub for your information. Many payers will not even review your application until your CAQH is complete and attested.
Review your profile and confirm that:
- All licenses, malpractice policies, and practice locations are listed
- Your resume or CV is uploaded and current
- You have uploaded your W-9 and any other requested documents
- Your attestation is up to date and you have allowed payers to access your file
A good rule of thumb is to log in to CAQH at least every 90 days to keep it current, even after you are fully credentialed.
7. Business Information (If Applicable)
If you are applying as a group practice or a solo provider with an LLC or corporation, gather:
- Your EIN confirmation letter
- Articles of incorporation or business registration
- Your Type 2 NPI if billing under the business
- Practice address and mailing address (if different)
Using consistent business details across CAQH, W-9, and applications will prevent a lot of confusion on the payer side.
8. Billing and Contact Information
Someone has to be the point person when payers have questions. Decide up front who that will be.
Clarify:
- The name, email, and phone number for credentialing and contracting contact
- Whether that will be you, an office manager, or your credentialing specialist
- Where paper mail, checks, or important notices should be sent
If you work with a biller or credentialing specialist, make sure they are listed in the appropriate contact fields so they can speak to payers on your behalf.
Quick Tips To Stay Organized
- Create a digital “Credentialing” folder in Google Drive, Dropbox, or OneDrive
- Save every document as a PDF with clear names, for example: Lastname_NPI, PracticeName_W9_2025.
- Use consistent spelling and abbreviations for your name, credentials, and practice name
- Keep a simple spreadsheet that lists which version of each document you used and when it was last updated
This will also make re-credentialing and adding new payers much easier in the future.
Common Mistakes To Avoid
- Submitting expired or soon-to-expire licenses or malpractice policies
- Forgetting to complete or update your CAQH attestation
- Using different practice addresses across forms without explanation
- Leaving long employment gaps with no context
- Ignoring emails from payers that request follow up information
Small inconsistencies can slow everything down. A few extra minutes of double-checking up front can save months of waiting later
What Is Next?
Once your documents are in order, you are ready for the next step: actually applying to insurance panels.
In Part 3, we will walk through how to apply to major insurance companies such as BCBS, Aetna, Cigna, and United, along with realistic timelines and tips to avoid common delays.
Feeling overwhelmed already?
I help private practice providers gather these pieces, clean up CAQH, and manage credentialing from start to finish so you do not have to. Reach out any time if you would like support.
