Credentialing & Enrollment · Payers

Payer Credentialing Guides: How to Get In Network With Each Major Payer

Medicare, Medicaid, Aetna, Cigna, Blue Cross Blue Shield, UnitedHealthcare, Humana and TRICARE side by side: where to apply, whether CAQH is used, what each payer publishes about timing, and how to check status.

Payer credentialing, also called payer enrollment or getting on insurance panels, is the process each health insurer uses to verify a provider's license, training, work history and malpractice record and then contract with them, and it is done payer by payer: every plan has its own door, its own review, its own contract and its own effective date. There is no single application that puts a provider in every network.

This page is the index: one table comparing the eight payers most practices start with, then a short summary of each and a link to the full guide. If you want the general sequence that applies to every payer (documents, order, contracting), read how to get in network with insurance companies. For the definitions, see what provider credentialing is.

Updated 2026-10-23. Reviewed by Jacob Greenberg, ClaimCarePro.

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Payer enrollment compared: 8 payers side by side

Every cell is the payer's own published wording, from the guide linked in the first column (pages read October 23, 2026). Payers change these pages; follow the guide before you file.

Payer credentialing and enrollment compared across Medicare, Medicaid, Aetna, Cigna, BCBS, UnitedHealthcare, Humana and TRICARE
Payer	Where you apply	CAQH?	Payer-published timeline	Status check	Behavioral health route
Medicare	NPI, then CMS-855I (individual) / CMS-855B (group) in PECOS	No — PECOS, not CAQH	CMS contractor standard, PECOS with no development or site visit: 95 percent within 15 calendar days, all within 50 (CMS Program Integrity Manual ch. 10)	Your MAC (First Coast in Florida); answer any development request within 30 days	Same CMS-855I route as other individual practitioners
Medicaid	Each state’s own portal (Florida: Florida Medicaid Web Portal, FLMMIS Enrollment Wizard)	State application; managed-care plans credential separately	Florida AHCA: 60 days or less from a complete application	Florida: FLMMIS Enrollment Status, with the tracking number and the name exactly as submitted	Varies by state; see the Medicaid guide
Aetna	Online request for participation, one NPI Type 1 application per provider	Yes, after Aetna decides it needs you; kit within 10 business days if not registered	Decision on the request within 60 days; no overall total published (Aetna join page)	1-800-353-1232 (medical and behavioral health); Missouri: online status form	Same request for participation form as medical
Cigna	Call 1 (800) 88CIGNA, credentialing option; packet by email	Accepted as the application (or One Healthport, or a state application)	Typically 45 to 60 days (cigna.com credentialing page)	PSSCentral@Cigna.com with name and TIN, or 1 (800) 882-4462	Evernorth Provider Portal; up to 90 calendar days (Evernorth)
Blue Cross Blue Shield	The local Blue plan’s own door (Florida Blue: Availity; BCBSTX and BCBSIL: Provider Onboarding Form)	Yes at most large plans; BCBSTX ends the process if CAQH is not finalized in 45 days	Plan by plan: Anthem typically 45 days from a completed CAQH application; Horizon up to 90 days; Florida Blue a written decision within 30 business days of committee	Plan tools: Case Status Checker (BCBSTX, BCBSIL); Florida Blue 1-800-727-2227 after 90 days of silence	Florida Blue delegates behavioral health to Lucet; check your provider type is contracted
UnitedHealthcare	Onboard Pro in the UnitedHealthcare Provider Portal (One Healthcare ID)	CAQH ID “if applicable,” UHC authorized; Optum: required in most states	Up to 45 calendar days or more from a complete application, then up to 60 days to load the contract (UHC join page)	Onboard Pro dashboard; Optum: Provider Express, Check Initial Credentialing Status	Optum Behavioral Health through Provider Express; no day count published
Humana	Online join form (Florida and 11 other listed states) or regional email; Florida also a Letter of Interest	Required for individual providers (Arkansas excepted)	No national figure; Medicare-only providers in non-delegated groups: effective 30 calendar days after all documents arrive	1-800-626-2741	Behavioral Health Provider Inquiry Form (online form in seven listed states)
TRICARE	Certification with the regional contractor first: Humana Military (East, incl. Florida) or TriWest (West)	TriWest: CAQH ID on the roster or its own application; Humana Military: documents by secure message	Humana Military: paper certification approximately 90 days; no network-credentialing timeline published	Humana Military certification status tracker; TriWest provider contacts	East network form taking only autism, psychiatry, mental health and substance abuse requests (as of 10/23/2026)

Read the timeline column carefully. Each figure is the payer's own wording about its own step, and the steps differ: Aetna's 60 days is the network-need decision, not the whole process; UnitedHealthcare's 45 days is followed by up to 60 more to load the contract; Medicare's figures are CMS's processing standards for its contractors. Where a payer publishes nothing, we say so instead of guessing. Every clock starts on a complete file, which is why the documents matter more than the date you mail it.

Credentialing guides by payer

The one-paragraph version of each guide. The full guide has the steps, forms, phone numbers and sources.

Medicare provider enrollment: PECOS, CMS-855, PTAN

Medicare enrollment means applying for billing privileges: get an NPI, file the right CMS-855 in PECOS, your Medicare Administrative Contractor reviews it, and you receive a PTAN and an effective date. No CAQH, no committee.

Medicaid provider enrollment, state by state

Medicaid enrollment is run by each state under a federal floor. In Florida you apply through the Florida Medicaid Web Portal; Medicaid managed-care plans then credential you separately.

Aetna credentialing and enrollment

Aetna starts with an online request for participation, not with CAQH. It decides whether its network in your area needs you, which it says takes up to 60 days, then pulls your CAQH profile and finalizes the contract once credentialing is complete.

Cigna credentialing (incl. Evernorth behavioral health)

Cigna starts with a phone call to 1 (800) 88CIGNA, sends a packet, and accepts your CAQH profile as the application; it says medical credentialing typically takes 45 to 60 days. Behavioral health clinicians apply to Evernorth instead.

Blue Cross Blue Shield (Florida Blue, Anthem, BCBSTX…)

BCBS is done plan by plan: the association is 33 independent companies, so you apply to the Blue plan where you practice, through that plan’s own join page, portal, committee and contract.

UnitedHealthcare & Optum

Medical and surgical providers request participation in Onboard Pro inside the UnitedHealthcare Provider Portal; behavioral health providers apply to the Optum Behavioral Health network through Provider Express.

Humana credentialing

Humana reads a complete CAQH ProView profile you have authorized, takes a request to join through its online form or regional contact, verifies the file and decides at its Credentials Committee, separately from the contract.

TRICARE (Humana Military East / TriWest West)

TRICARE is two steps run by a regional contractor: certification makes a provider “TRICARE-authorized,” then network providers add credentialing and a contract. Florida is in the East Region, run by Humana Military.

Which payers should a new practice apply to first?

For most new practices the order is Medicare, then Medicaid, then the commercial plans your patients actually carry. That is an order of operations, not a ranking of payers, and three published rules drive it.

Medicare first, because its back-billing window is short. Your Medicare effective date is the later of the date you filed the application that was approved or the date you started seeing patients at that location, and you can bill for services up to 30 days before it (42 CFR 424.520(d)). Every week the application is not filed is a week of Medicare visits you may not be able to bill. Details are in Medicare provider enrollment: PECOS, CMS-855, PTAN.
Medicaid next, because Medicaid plans need it. Federal rules require each state to screen and enroll every provider in its Medicaid managed-care networks (42 CFR 438.602), and UnitedHealthcare's Indiana Community Plan page says to enroll with the state Medicaid program first. See Medicaid provider enrollment, state by state.
Then the commercial and Medicare Advantage plans your patients carry. Medicare Advantage plans run their own credentialing under 42 CFR 422.204, separate from traditional Medicare, so each is its own application. Pick them by your patient mix: ask the front desk which cards come in most, and apply to those plans in parallel, not one at a time.

Before any commercial application, check that the plan contracts your provider type. Florida Blue's provider manual excludes several types, among them behavioral health practitioners and chiropractors, unless explicitly included, and TRICARE does not cover chiropractic care at all. Our new-practice bundle follows this order: CAQH, Medicare, Medicaid and six commercial payers per provider.

What is the same across every payer

The doors differ. The data, and what stalls it, does not.

One CAQH profile, kept current. Most commercial plans read the same CAQH profile, so it has to be complete, attested every 120 days (180 in Illinois, per CAQH's quick reference guide) and authorized for each plan. One lapse stalls every plan reading it. See what CAQH is.
The right NPI in the right place. An individual (Type 1) NPI for the provider and an organizational (Type 2) NPI for the group, matching the tax ID and legal name on the W-9 everywhere they appear.
The same documents. License, DEA where applicable, malpractice face sheet, CV with work history by month and year, W-9. Our credentialing intake list is the full set, in one place.
Credentialing and contracting are separate. At Aetna, Humana and UnitedHealthcare both must finish before you are in network, and a mailed contract is not an approval. Bill as in network only from the effective date in the payer's letter.
Weekly follow-up. No payer reliably tells you that a file is waiting on you. We call or check each payer every week and log the representative, the date and the reference number, so a request for a missing item is answered the week it is made.

Why payer applications stall, across every payer
Stall cause	What it looks like
Addresses that disagree	The practice address on CAQH, the payer application, NPPES or PECOS and the state license reads three different ways, often an old office or a missing suite number.
NPI or tax ID mismatch	Individual and group NPIs swapped, or a legal name and tax ID that read differently on the W-9, the application and CAQH.
Lapsed or expired documents	A renewed license, DEA or malpractice face sheet never uploaded, so verification finds an expired copy.
CAQH not attested or not authorized	The profile lapsed past its 120-day re-attestation, or the plan waiting to read it was never authorized.
Wrong door	A therapist on a medical route, a Medicare Advantage request sent to the commercial plan, or a TRICARE network request before certification.
Requests left unanswered	A payer’s request for a missing item, or a Medicare development letter, sits in an inbox while the payer’s clock runs.

In our casework, applications stall most often on bad data from the providers, not on the payers. The fix is the same at every plan: check the application, CAQH, NPPES, the state license and the W-9 against each other before anything is filed.

Insurance credentialing services: what we do and what it costs

Insurance credentialing services file the payer applications, keep the CAQH profile current, answer every payer request and follow up until each payer issues an effective date. Most credentialing companies quote after a call; ClaimCarePro publishes its prices:

$250 per payer application, per provider, with weekly follow-up
$250 CAQH setup or cleanup, per provider
$250 re-credentialing, per payer
$99 per provider per year for maintenance (CAQH re-attestation, expirables)
$1,750 new-practice bundle per provider ($1,400 for each additional provider on the same group and payers)

Full details are on credentialing services, with a worked example in how much credentialing costs. Our team has 30+ years combined in medical billing and credentialing.

Payer credentialing questions, answered

What is payer credentialing?

Payer credentialing is the review a health insurer runs before it adds a provider to its network: it verifies license, education, work history, malpractice coverage and sanctions, usually from the provider’s CAQH profile, and a committee decides. It is done payer by payer. Every plan runs its own review, its own contract and its own effective date.

What is the difference between credentialing and payer enrollment?

Credentialing is the verification step; enrollment is getting set up to bill the payer. Commercial plans add contracting after credentialing, and both must finish before you are in network. Medicare uses the word enrollment: you file a CMS-855 in PECOS, your Medicare Administrative Contractor reviews it, and you get a PTAN and an effective date. Medicaid enrollment is run by each state.

Do I have to apply to every insurance company separately?

Yes. There is no single application that puts you in every network. A complete, attested CAQH profile lets most commercial plans read the same data, but each still needs its own request to join, its own verification and its own contract. Even Blue Cross Blue Shield is 33 independent companies, so you apply to the Blue plan where you practice.

How long does insurance credentialing take?

It depends on the payer, and only some publish a figure. Cigna says medical credentialing typically takes 45 to 60 days. UnitedHealthcare says up to 45 calendar days or more from a complete application, then up to 60 days for the contract to load. Aetna says it decides on a request within 60 days. Anthem says typically 45 days from a completed CAQH application. Florida’s Medicaid agency says 60 days or less from a complete application. Every clock starts on a complete file.

Which insurance panels should a new practice join first?

Usually Medicare, then Medicaid, then the commercial plans your patients actually carry. Medicare limits billing to 30 days before your effective date, so filing early matters. Many Medicaid managed-care plans need state Medicaid enrollment first. Commercial plans and Medicare Advantage plans each run their own credentialing, so pick them by your patient mix and check that each plan contracts your provider type.

What do insurance credentialing services do?

A credentialing service prepares and files the applications, sets up and maintains the CAQH profile, answers payer requests for missing items, follows up until each payer issues an effective date, and tracks the re-credentialing and revalidation dates after that. ClaimCarePro charges a flat $250 per payer application per provider, $250 for CAQH setup and $99 per provider per year for maintenance.

Does every payer use CAQH?

No. Most commercial plans read CAQH: Aetna uses it to credential, Humana requires it for individual providers, Cigna accepts it as the application, and most large Blue plans build on it. Traditional Medicare does not use CAQH; it enrolls providers through PECOS. State Medicaid programs use their own enrollment applications, and TRICARE starts with certification through a regional contractor.

What does it mean when an insurance panel is closed?

It means the plan has decided its network in your area does not need another provider of your type. Aetna, for example, reviews network need first and sends a denial by letter or email if the panel is closed. UnitedHealthcare lets you request a reassessment if you offer specialized care not otherwise available, are buying a practice already in its network, or have another reason.

Related guides

Hand us the payer list

Tell us which providers and which payers. We price it from the published table before any work starts: $250 per payer application per provider, or the $1,750 new-practice bundle.

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Sources

Payer pages as cited by each guide, all read October 23, 2026.