Recredentialing and Credentialing Maintenance: What Recurs, When, and What It Costs
The five clocks that keep running after a provider's effective date, what each payer says happens when one is missed, and a five-year calendar priced line by line.
Recredentialing is a health plan re-verifying a provider already in its network, at least every 36 months at plans that follow NCQA standards. It is one of several clocks that start on the effective date: CAQH re-attestation every 120 days, Medicare and Medicaid revalidation at least every five years, and every license, DEA registration and malpractice policy on its own date. Miss one and the consequence is not a late fee; it is claims that stop paying.
If you are still at the first application, start with what provider credentialing is. This page is about everything after approval.
Last updated October 16, 2026. Reviewed by Jacob Greenberg, ClaimCarePro.
Every recredentialing cycle, with its source
What recurs, how often, and what the payer or regulation says happens when it is missed. All sources read October 16, 2026.
| Clock | How often | If it is missed | Source |
|---|---|---|---|
| CAQH re-attestation | Every 120 days; 180 days for providers practicing in Illinois | Profile no longer current. Florida Blue designates a provider whose profile is not current during recredentialing a “non-responder” and says the agreement could be affected | CAQH quick reference; Florida Blue bulletin |
| Commercial and managed-care recredentialing | At least every 36 months from the last credentialing decision at plans following NCQA standards | Humana: may be administratively decredentialed; reactivation possible within 30 calendar days, after that initial credentialing again. Cigna: no response to the recredentialing request “will result in termination” from the network | NCQA; Humana policy; Florida Blue manual; Cigna |
| Medicare revalidation | Generally every 5 years (DMEPOS suppliers every 3). CMS posts due dates 7 months ahead, can call an off-cycle revalidation, and gives 60 calendar days to respond to a request | Payment hold or deactivation of billing privileges; reactivation needs a new application, and services during the gap are not paid | CMS revalidations; 42 CFR 424.515 |
| Medicaid revalidation | At least every 5 years, set by each state Medicaid agency; managed-care plans then recredential on their own cycles | Set by each state agency in its provider notices; a managed-care plan contract does not keep a lapsed state enrollment alive | 42 CFR 455.414 |
| Medicare inactivity and change reporting | No Medicare claims for 6 consecutive calendar months triggers deactivation. Changes of ownership, adverse legal action or practice location must be reported within 30 days; all other changes within 90 | Deactivation of billing privileges | 42 CFR 424.540; 42 CFR 424.516 |
| License, DEA registration, malpractice coverage | Each on its own expiration date, set by the board, the DEA or the carrier | The next verification, CAQH or payer, finds an expired document; a lapsed license or DEA registration also stops the provider practicing | The issuing board, DEA, carrier |
Two rows surprise practices most. The Medicare inactivity rule catches a provider who works part time or covers a location only occasionally: six months with no Medicare claim and the billing privileges are deactivated, with no revalidation date involved. And the 30-day practice-location rule means a move or a new office is a Medicare deadline, not just a CAQH update.
Recredentialing vs revalidation
Same idea, different agencies, different paperwork.
Recredentialing is a commercial or managed-care plan repeating its own check. Humana's policy lists what it re-verifies before the committee decides again: a current license, a current DEA or state controlled-substance certificate, board certification where applicable, malpractice claims history from the National Practitioner Data Bank, and sanctions (Humana policy). Most plans read the CAQH profile for this; Cigna starts its recredentialing by emailing the provider to confirm CAQH is current (Cigna), and Florida Blue asks for an updated application and documentation (Florida Blue manual).
Revalidation is Medicare or Medicaid asking the provider to resubmit and recertify the enrollment record itself. Medicare revalidation runs through PECOS; CMS publishes a revalidation list with each provider's due date (CMS). How PECOS works is on our PECOS page.
One provider's first five years, on a calendar
A provider enrolled with Medicare, Medicaid and four commercial plans, priced at our published rates.
| What recurs | How many times in 5 years | How it is billed | Cost |
|---|---|---|---|
| CAQH re-attestations | 15 (one every 120 days) | Maintenance | $99 × 5 years = $495 |
| Recredentialing files, 4 commercial plans | 4 (each plan once, each on its own 36-month date) | $250 per payer when due | $1,000 |
| Medicare revalidation | 1 | $250 when due | $250 |
| Medicaid revalidation | 1 | $250 when due | $250 |
| License, DEA, malpractice renewals | On their own dates | Maintenance tracks them; the renewals themselves are yours | Included in the $99 |
| Total | 21 dated filings, plus document renewals | $1,995 over five years |
The count is arithmetic from the cycles above: 1,826 days divided by 120 is 15 CAQH attestations; each NCQA-standard plan recredentials at least once inside 36 months; Medicare and Medicaid each revalidate once. The cost assumes each cycle arrives once. An off-cycle Medicare revalidation, or a plan that recredentials sooner, is one more $250 file. The plans do not line up: four plans credentialed in four different months recredential in four different months, which is the reason a calendar beats memory.
What credentialing maintenance actually does
The clock-keeping between applications, not another application.
In our casework, credentialing files stall on bad data from the providers far more than on the payers, and between cycles that data drifts. A provider moves suites and updates the payer but not CAQH. A malpractice policy renews and the new certificate never gets uploaded. A group changes its tax ID and one plan still has the old one. Nothing breaks that day. It breaks at the next verification, when the payer reads two versions of one provider. The errors are the ones in our CAQH profile error table; maintenance is the work of never letting them form.
For $99 per provider per year, ClaimCarePro's maintenance covers:
- CAQH re-attestation inside every 120-day window, with the profile reviewed, not just re-clicked.
- Expirables tracking: license, DEA registration and malpractice certificate dates on a calendar, with the renewed document requested from you and uploaded before the old one lapses on the profile.
- Address and tax-ID updates pushed to CAQH and the payers so every record agrees, including the Medicare practice-location change that has a 30-day reporting rule.
What it does not include: the recredentialing and revalidation applications themselves. Those are $250 per payer when they come due, the same as an initial application, with weekly payer follow-up until the payer confirms. You pay for the cycles that actually arrive, not a retainer. Full pricing, including the $1,750 new-practice bundle, is on provider credentialing services.
Recredentialing questions, answered
What is recredentialing?
How often do providers need recredentialing?
What is the difference between recredentialing and revalidation?
What happens if I miss recredentialing?
What happens if I miss Medicare revalidation?
Do I have to re-attest CAQH if nothing changed?
How much does recredentialing cost?
What is credentialing maintenance?
Prefer to talk first? Contact us or call (844) 772-8902.
Last updated October 16, 2026. Reviewed by Jacob Greenberg, ClaimCarePro.