Credentialing 101: The Basics - What do I need to get started?

Insurance companies (payers) are often meticulous in their process of credentialing (also referred to as paneling). While each payer may have a different process to verify a clinician, they often request a lot of the same information.  

Below is a compiled list of the items you will need on hand to start the process of credentialing. It's recommended that you keep the raw information in a spreadsheet that is easy to update, and digital documents in a folder that is secure and easy for you to access.

Get a free Provider Information Template when you subscribe to Honored Healthcare Systems with your email here.

Documents/Information Required for Insurance Credentialing:

Personal & Professional Information 

• Full legal name, DOB, SSN (sometimes required for background checks) 

• Current home and practice addresses 

• Contact information (phone, email, fax) 

• Copy of driver’s license or government ID 

Professional Licenses & Certifications 

• Active state license(s) (unrestricted) 

• DEA certificate (if applicable) 

• Board certifications (if applicable) 

• State-controlled substance registration (if applicable) 

Education & Training 

• Medical/graduate school diploma 

• Internship, residency, fellowship documentation (if applicable) 

• Continuing education records (sometimes requested) 

Work History 

• Detailed CV or résumé (with month/year for each role, no gaps >30 days) 

• Employment/clinical history for at least the past 5–10 years 

Insurance & Legal Documentation 

• Malpractice insurance certificate (current and adequate coverage) 

• Malpractice claims history / loss run report (typically past 5–10 years) 

• Explanation for any malpractice suits, disciplinary actions, or sanctions (if applicable) 

• National Provider Identifier (NPI) number 

• Tax ID (EIN) or SSN for solo providers 

Business & Practice Information 

• Practice name and address(es) 

• Taxonomy specialty codes 

• CLIA certificate (if you perform lab tests in-office) 

• Business license (if required by state) 

• W-9 form 

Background Checks & Authorizations 

• CAQH profile (Council for Affordable Quality Healthcare) – many insurers pull directly from here 

• Attestation of truthfulness and accuracy of submitted documents 

• Signed release for background, criminal, and credit checks 

Tip: Having an updated CAQH profile with all documents uploaded and attested makes the process much faster, since most insurers check there first.