Recredentialing is one of the most important — but often overlooked — parts of staying active with insurance networks.
Even if a provider has been credentialed before, payers require regular rechecks to ensure they still meet all quality, licensure, and compliance standards.
Whether you’re a solo provider, part of a group practice, or manage a large healthcare organization, understanding how recredentialing works can save you time, prevent denials, and protect your revenue. This guide breaks it down in simple words.
Key Takeaways
- Recredentialing is the mandatory, periodic (2-3 year) verification process required by insurance payers to keep a provider in-network.
- Risk: Missing the deadline directly causes claim denials, payment holds, and significant lost revenue.
- Timeline: The process takes 30–90 days; start proactive preparations 120 days before the due date.
- CAQH is Critical: Attest and update your CAQH profile every 90 days, regardless of changes, to prevent the #1 cause of delays.
- Prevent Expiration: Renew all state licenses and certifications (DEA, CDS) early to ensure they are active throughout the review period.
Why Recredentialing Matters
Recredentialing is the process of verifying a provider’s qualifications again, usually every 2–3 years. Insurance companies do this to make sure the provider still meets their standards and has kept all licenses, certifications, and background checks up-to-date.
If recredentialing is delayed or incomplete, a provider can be removed from the network, leading to:
- Claim denials
- Payment holds
- Interrupted patient care
- Loss of revenue
That’s why completing recredentialing on time is essential for every practice.
What Is Recredentialing?
Recredentialing is the payer’s periodic review of a provider’s professional information to ensure they remain qualified and compliant.
It includes re-verifying:
- State licenses
- DEA and CDS certificates
- Board certifications
- Education and training
- Malpractice insurance
- Work history
- Sanctions or disciplinary actions
- Hospital privileges
Think of it as a “renewal” of your provider profile with each insurance company. Nothing is assumed — everything is checked again.
How Recredentialing Differs from Initial Credentialing
Many providers confuse credentialing and recredentialing. Here’s the difference in simple terms:
| Initial Credentialing | Recredentialing |
| Happens when a provider joins a payer network for the first time | Happens every 2–3 years after joining |
| Full review of the provider’s entire professional history | Review of updates since the last credentialing |
| The purpose is to approve network participation | The purpose is to maintain network participation |
| Missing documents delay initial approval | Missing documents can cause termination |
Both are important, but recredentialing is time-sensitive because it affects existing reimbursements.
How Often and How Long It Takes
Most payers — including Medicare, Medicaid, and commercial plans — follow a standard cycle.
How Often
- Every 2 years for many payers
- Every 3 years for some commercial plans
- Some organizations (like hospitals) do it annually
How Long Does the Process Take
- The recredentialing review typically takes 30–90 days
- Some payers may take up to 120 days
When Providers Are Notified
Payers usually send reminders:
- 90–120 days before the due date
- Via email, portal notifications, or mailed letters
Missing these reminders is one of the biggest reasons providers fall out of network.
Required Documents for Recredentialing
Recredentialing requires updated documents and accurate information.
Payers commonly request:
- Active state medical license (must not be expiring soon)
- DEA/controlled substance registration
- Board certification status
- Current malpractice insurance
- Explanation of any gaps in work history
- Hospital privileges list
- Updated CV
- Peer references (in some cases)
- Attestation forms confirming accuracy
You must also ensure your CAQH profile is current and attested, since many payers pull information directly from CAQH.
What Happens During the Recredentialing Process?
Here’s the step-by-step process in simple terms:
Step 1: Payers Request Updated Information
The insurance company sends a notice asking providers to update their CAQH or submit documents.
Step 2: Verification Begins
Payers check:
- License and certifications
- Malpractice history
- Background checks
- Sanctions or disciplinary actions
- Hospital affiliations
- Provider performance or quality issues
Step 3: Committee Review
A credentialing committee reviews all verified information.
Step 4: Approval or Denial
- If approved, → provider stays in-network
- If denied, → payer may request additional documents
- If not submitted, → provider may be removed from the network
If a provider is terminated, they must restart initial credentialing, which delays billing for months.
Common Challenges Providers Face with Recredentialing
Recredentialing seems simple, but many providers experience issues like:
- Missed Deadlines
Busy providers often overlook payer reminders, leading to network termination.
- Expired or Soon-to-Expire Documents
If a license or DEA is expiring within 30–60 days, payers may delay approval.
- Incomplete CAQH Attestation
Outdated or unattested CAQH profiles cause automatic recredentialing holds.
- Incorrect or Missing Information
Small errors — like outdated addresses or missing work history dates — can stop the process.
- Staffing or Administrative Gaps
Practices without a credentialing team struggle to track timelines across many payers.
Best Practices to Keep Recredentialing Smooth and On-Time
Use these proven strategies to avoid delays or denials:
- Track All Recredentialing Dates
Use:
- A spreadsheet
- A simple calendar system
Mark reminders 120, 90, and 60 days before deadlines.
- Keep CAQH Updated Frequently
Update and attest every 90 days, even if nothing changes.
- Maintain All Licenses & Certifications Early
Start renewal processes months ahead so nothing expires during recredentialing.
- Store All Documents in One Place
Digital folders for:
- DEA
- State license
- CV
- CME certificates
- Malpractice insurance
Make uploads quick and accurate.
- Respond Quickly to Payer Requests
Delays in submitting forms or documents stop the entire review.
- Use Credentialing Software or a Professional Service
Many practices reduce errors and save time by outsourcing recredentialing to experts who track deadlines and manage submissions.
FAQ
Recredentialing is the process where insurance companies review your qualifications again—typically every 2 to 3 years—to ensure your licenses, certifications, and background remain current so you can stay in their network.
Initial credentialing is the first full review when you join an insurance network. Recredentialing is a quicker follow-up review done every few years to confirm that nothing significant has changed since your last approval.
Most insurance companies require recredentialing every 2 to 3 years. Some organizations, such as hospitals, may review providers annually. You will usually receive reminders 90 to 120 days before your due date.
You will need your current state license, DEA certificate, malpractice insurance certificate, updated CV, hospital privileges list, and an up-to-date CAQH profile. All documents should be current and not close to expiration.
If you miss the deadline, you may be removed from the insurance network. This can cause claim denials, payment delays, and disruptions in patient access. In many cases, you would need to restart the full credentialing process to rejoin the network.
You can simplify recredentialing by tracking important dates, keeping your CAQH profile updated every 90 days, renewing licenses early, maintaining digital copies of key documents, responding quickly to payer requests, and using credentialing software or a credentialing service for support.