Nobody hands this to a new practice
Who this is for. Providers trying to get credentialed with insurance companies, who are tired of a path nobody explains the same way twice. This page gives it to you straight: exactly what to do, in what order, who to call, and what it costs. Then our software takes care of the part that comes after — the claims, the checks and the payer’s answer in plain words.
All of it is public. None of it is in one place. It is scattered across fifty websites, half of it inside PDFs, and written for billing departments rather than for the doctor who has just signed a lease. That gap is what consultants build companies on.
We are not the middle man in it. We did the research, wrote it down in order, and put it here. If it makes you think LogBlues is the right partner for your practice, good. If it just gets you paid sooner, that is fine too.
Everything on this page was checked on 7 September 2026 against each organization’s own website. Nothing was copied from a billing company, a blog or a directory. Where a company does not publish a phone number for doctors, this page says so instead of handing you a number that reaches the wrong desk.
Three words to get straight first
Most of the confusion in insurance billing is three words being used as if they meant the same thing. They do not, they happen months apart, and only one of them decides whether you get paid.
Payer
An insurance company, in the language the industry uses. Aetna is a payer. So are Medicare, Medicaid and TRICARE. When a billing person says “which payer”, they mean which insurance company.
Clearinghouse
The company that carries claims from your software to the payer, and carries the payer’s answer back. It is a mail service, not an insurance company. You enroll with it separately, and it is the only part of this page that has anything to do with software.
Credentialing, contracting, enrollment
The payer checking you out. The payer signing your rates. Permission to send files electronically. Three separate things. Contracting is the one that decides whether you are paid, and it is the one people forget to finish.
If somebody tells you they are credentialed but still not getting paid, it is almost always the middle one — contracting — that they never completed. Being credentialed means the payer checked you out. Being paid means you signed their agreement, and that agreement has a start date — bill for visits before it and they come back unpaid every time.
The order to do things in
Steps 1 and 2 block everything else, so do them first. Steps 4, 5 and 6 are independent of each other and should start the same week.
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1
Get your NPI
Your National Provider Identifier, a ten-digit number. Free, online, and every other application on this page asks for it. If you are incorporated you need two: a Type 1 for you as a person, a Type 2 for the business.
Apply: nppes.cms.hhs.gov · Phone: 1-800-465-3203, the NPI Enumerator.
CMS is blunt about what it does not do: “Having an NPI does not: Ensure a provider is licensed or credentialed; Guarantee payment by a health plan; Enroll a provider in a health plan.” It is step one of eight, not the finish line. Report any change to your details within 30 days.
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2
Build your CAQH profile, and attest to it
Free. Most commercial payers pull your credentialing file straight out of CAQH rather than asking you for paper. A profile that has not been attested is the most common reason an application sits still for months.
Sign in: proview.caqh.org · Phone: 1-888-599-1771, provider support, Monday to Friday.
Do not be alarmed by the new name. CAQH now trades as DataSpring and caqh.org redirects to dataspring.com, but the login is still proview.caqh.org and every payer still writes “CAQH ProView” in its instructions. It is the same organization, not a phishing page.
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3
Get your documents into one folder
Every application after this point asks for the same fifteen or so items. Gathering them once saves weeks. The checklist is below.
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4
Enroll in Medicare through PECOS — and find out who your MAC is
An individual doctor files Form CMS-855I. A group files the CMS-855B. Neither pays a fee.
Enroll: pecos.cms.hhs.gov
Then find your Medicare Administrative Contractor. CMS does not process your claims. A regional contractor does, and that is who you will actually deal with. Get this wrong and your paperwork goes to a company that does not serve your state. In Illinois it is National Government Services, Jurisdiction 6 — not the contractor most lists name.
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5
Enroll in your state’s Medicaid program
This is a state agency, not a federal one, and every state does it differently. In Illinois it is the IMPACT system run by Healthcare and Family Services: hfs.illinois.gov/impact, phone 1-877-782-5565, option 1 for a Provider Enrollment Specialist.
In Illinois this is not optional even for commercial work. Both Meridian and Molina credential their Illinois Medicaid providers through IMPACT, so state Medicaid enrollment is a prerequisite for those contracts rather than a parallel track.
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6
Apply to the commercial payers, biggest first
In order of how many of your patients carry each card. Do not fire off all of them on day one — each is a live application somebody has to chase. The payer list below has the application page and the phone number for each.
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7
Register for Availity if your payers use it
Availity is a shared portal and clearinghouse: one login instead of one per payer, for eligibility, claim status, remittances, appeals and prior authorizations. The base tier is free.
Register: availity.com · Phone: 1-800-282-4548 · check whether your payers are on it.
Of the payers below, Aetna, Anthem, Humana, Molina, Ambetter, Blue Cross Illinois and TRICARE West all route provider work through Availity. UnitedHealthcare and Cigna run their own portals. Note that Availity handles transactions, not joining — you still apply on the payer’s own page.
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8
Put the upkeep in a diary
CAQH re-attestation, Medicare revalidation, and each payer’s re-credentialing cycle. These are the dates that quietly switch off payment when they are missed, and nobody sends a reminder.
CAQH asks for re-attestation every 120 days in most of the country, and every 180 days in Illinois. Blue Cross Illinois re-credentials every three years.
While those applications sit there
Credentialing takes months and there is very little to do but chase it. Setting the software up takes an afternoon. Get the clinic running on it now, learn it on the quiet weeks, and be ready to bill on the day your first contract starts rather than three weeks after.
What it costs: almost nothing
This is the part the people selling credentialing packages tend not to lead with. The applications are free. The NPI is free. The CAQH profile is free, in their own words: “health care providers may use the Provider Data Portal to enter, maintain and share their professional and practice information free of charge.” No commercial payer on this page publishes an application fee. Nobody is ever selling you credentialing — they are selling you the hours.
Nothing on this page is a LogBlues charge. Every fee here is charged by a government agency or an insurance company, and it is paid to them directly. We do not collect it, mark it up, or take a share of it. This page is a guide to somebody else’s prices.
There is one real fee on the whole path, it is charged by Medicare, and for a doctor it almost certainly does not apply.
| Who is enrolling | Form | Fee for 2026 |
|---|---|---|
| Individual physician or non-physician practitioner | CMS-855I | No fee |
| Clinic or group practice | CMS-855B | No fee |
| Institutional provider — hospital, home health, hospice, surgical center, laboratory, nursing facility | CMS-855A | $750 |
| Equipment supplier — durable medical equipment, prosthetics, orthotics, supplies. This one does catch physicians. | CMS-855S | $750 |
So the honest answer to “do I pay $750 to join Medicare?” is no, unless you are enrolling an institution or billing durable medical equipment. CMS’s matrix lists Physician, Non-Physician Practitioner and Clinic/Group Practice as No for both initial enrollment and revalidation.
The documents to have in hand
Scanned, current, in one folder, before you start any application.
Licenses and registrations
Your state medical license, current, and one for every state you will practice in. Your DEA registration if you prescribe controlled substances, plus the state controlled-substance license where your state issues one.
Malpractice insurance certificate
The current face sheet, showing carrier, policy number, limits and dates. An expired certificate stops an application dead, and it is the document most likely to lapse while you wait.
Curriculum vitae, month and year, no unexplained gaps
Credentialing staff stop and query any gap longer than about a month. Write the explanation in — parental leave, study, illness, a move — rather than leaving the hole for someone else to ask about. This single habit removes one of the most common rounds of back-and-forth.
Diplomas and board certificates
Medical school, and internship, residency or fellowship certificates. Board certification certificates if you are certified.
W-9, and your NPI confirmations
The IRS form carrying your Tax Identification Number and legal business name, plus the NPI confirmation for you and for the practice entity. If you are enrolling a corporation, professional association or LLC with Medicare, they also want written IRS confirmation of the number and the legal name — for example an IRS form CP-575.
Three professional references
Peers in your specialty, with current email addresses and phone numbers. Warn them first. A reference who ignores an unexpected form from an insurance company will hold up your application for weeks without knowing it.
Hospital privileges, or your admitting arrangement
An admitting privileges letter, or your written arrangement if you have no privileges. Payers ask what happens to your patients when one needs admitting.
Explanation letters for anything adverse
A malpractice claim, a license action, a lapse in cover. Write the explanation yourself and attach it. None of it disqualifies you on its own. What stalls an application is an adverse item with no explanation next to it.
Your Social Security number — and how to hand it over
Applications ask for it, and Medicare requires it to match federal records exactly: Form CMS-855I states that “the provider’s Name, Date of Birth, and Social Security Number must match his/her social security record.”
Give that number directly to the payer or to CMS, on their own form or their own portal. Never through a third party, never as an email attachment, and never through a form you reached by a link somebody sent you first. LogBlues does not store Social Security numbers for this reason.
Medicare wants two extra forms
CMS-460 if you want to be a participating physician. CMS-588 for electronic funds transfer, with a voided check or a bank letter — though CMS notes that practitioners “who are reassigning all of their payments to a group/clinic or other health care organization are not required to submit the CMS-588.”
Payers, also known as insurance companies: where to apply, and who to call
UnitedHealthcare
Anthem Blue Cross Blue Shield (Elevance Health)
Aetna (CVS Health)
Cigna Healthcare
- Dental — 1-800-244-6224
- Behavioral health — 1-800-926-2273
Humana
Blue Cross and Blue Shield of Illinois (Health Care Service Corporation)
- Chicago metro — ChicagoMetro@bcbsil.com
- Rest of Illinois — CentralIL@bcbsil.com
- Government programs — govproviders@bcbsil.com
Molina Healthcare (Illinois)
Meridian (Centene’s Illinois Medicaid plan)
Ambetter (Centene’s marketplace brand)
TRICARE (military health)
- West — 888-874-9378 (TriWest). Say “Contracting” at the prompt.
- East — 800-444-5445 (Humana Military).
Kaiser Permanente
Every number above came off that company’s own website on 7 September 2026. Six of them don’t publish one for doctors at all — we say so instead of handing you a member services line and costing you a morning. Something moved? Tell us and we’ll fix it.
The traps that cost new practices weeks
Some of these bite wherever you practise. Others depend entirely on which state you are in, and those are the ones that catch people, because the answer a colleague gives you may be right for them and wrong for you.
Wherever you are
An un-attested CAQH profile
The single most expensive one. Most commercial payers pull your credentialing file straight out of CAQH, so a profile that has not been attested recently reads as stale and the application simply stops moving. Nobody writes to tell you. Re-attest on schedule and it never happens.
Billing before the effective date
Being approved is not the same as being live. Every contract carries a start date, and a claim for a visit dated before it comes back unpaid every time. Get the effective date in writing and do not see that plan’s patients as in-network until it arrives.
The wrong NPI on the claim
An incorporated practice has two National Provider Identifiers: a type 1 for the person and a type 2 for the business. They are not interchangeable, they sit in different boxes on the claim, and swapping them is a rejection that looks like a mystery.
Blue Cross Blue Shield is not one company
There is no national Blue Cross to contract with. You contract with the Blue company licensed in your state, and only that one. An application sent to the wrong Blue plan goes nowhere. Several Blue plans trade under names that do not say Blue — Anthem, Highmark, Premera, Regence, Wellmark and HCSC among them.
Letting a renewal lapse
Medicare asks you to revalidate on a cycle, and commercial payers re-credential on theirs, usually every three years. Both switch off payment when missed, and both are a calendar entry, not a task. Put every one of them in a diary the day you are approved.
Two payers that break the pattern
Cigna has no online application at all — it begins with a phone call. And UnitedHealthcare’s join page is case-sensitive, so the lower-case address returns a 404 and looks like a dead link. Neither is documented anywhere obvious.
Four questions only your state can answer
These four have a different answer in every state, and getting one wrong sends your paperwork to a company that does not serve you. Illinois is the worked example because it is where we are. Look yours up before you apply.
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1
Which Medicare contractor serves you
CMS does not process your claims. A regional Medicare Administrative Contractor does, and that is who you deal with. Look yours up on CMS’s own page, not on a blog: CMS publishes the list as a PDF that scrambles when it is converted to text, and a lot of secondary sources have copied the scrambled version.
Illinois, for example: National Government Services, Jurisdiction 6 — not the contractor most lists name.
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2
Which Blue plan holds your state
Find it on the Blue Cross Blue Shield Association’s own state list. Anthem is the Blue plan in fourteen states. Health Care Service Corporation is the Blue plan in five.
Illinois, for example: Blue Cross and Blue Shield of Illinois, part of Health Care Service Corporation. Anthem does not operate here.
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3
Which TRICARE region you are in
Military health is split into two regions with a different contractor each, and the name a clinic recognises is often the wrong one. Check tricare.mil/About/Regions first.
Illinois, for example: the West region, so TriWest — not Humana Military, which is East and is not currently accepting medical network requests at all.
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4
How your state runs Medicaid
Medicaid is a state agency, not a federal one. Every state has its own name for the programme, its own enrolment system and its own rules, and in some states enrolling with the state is a prerequisite for the commercial Medicaid plans rather than a separate track.
Illinois, for example: the IMPACT system at Healthcare and Family Services, and both Meridian and Molina credential their Illinois Medicaid providers through it. Workers’ compensation is state law too, and is a different system again from health insurance.
How long it really takes
Almost every figure you will read on this subject comes from companies selling credentialing services, and the popular “ninety to a hundred and eighty days” has no payer or CMS source behind it. Here is what the payers themselves publish, which is less than you would hope but is at least real:
- Medicare, filed electronically, is the quick one — most enrollments come back inside about three weeks.
- Aetna says a decision within 60 days.
- Cigna says 45 to 60 days once the pack is back with them.
- Meridian and Ambetter in Illinois say 20 business days just to review the form and decide whether contracting starts.
- UnitedHealthcare, Humana, Blue Cross Illinois, Molina and Kaiser publish no turnaround at all.
Plan on six weeks to four months for the commercial payers, start them all in the same week, and accept that the ones publishing nothing are the ones you will spend your time chasing. Timely filing matters here too: once you are live, Medicare gives you 365 days to file a claim, while Cigna and Anthem can give you 90. A practice running one follow-up rhythm across every payer loses money on the short ones — and a claim denied for late filing can never be billed to the patient.
Common questions
How do I get credentialed with insurance companies?
You apply to each insurance company separately. They check your licence, training, work history and malpractice cover — that is credentialing — and then you sign their contract and their rate sheet, which is what actually lets you get paid. Before any of it you need a National Provider Identifier (NPI) and a CAQH profile that has been attested, because most payers pull your credentialing file straight out of CAQH. There is no central place to apply and no software that can do it for you.
How long does credentialing take?
Six weeks to four months for the commercial plans, going by what the payers themselves publish. Aetna says a decision within 60 days. Cigna says 45 to 60 days once they have your pack. UnitedHealthcare, Humana, Blue Cross Illinois, Molina and Kaiser publish nothing at all. Medicare filed electronically is the quick one, usually back inside about three weeks. The popular “90 to 180 days” figure has no payer or CMS source behind it.
How much does credentialing cost?
Nothing to apply. The NPI is free, the CAQH profile is free, and neither Medicare, Medicaid nor any commercial payer charges a physician an application fee. Medicare has a $750 fee but CMS puts it on hospitals, laboratories and equipment suppliers — a physician or a group practice pays zero. When a company sells you credentialing, you are buying somebody’s hours, not access.
What is the difference between credentialing, contracting and enrollment?
Credentialing is the insurer checking the provider out. Contracting is signing their agreement and their price list, and it is the one that decides whether you are paid — this is what “in network” means. Electronic enrollment is permission to send claims and be paid electronically, arranged through the clearinghouse rather than with the insurer. When somebody is credentialed but still not getting paid, it is almost always contracting they never finished.
How do I join an insurance company’s network?
Through that company’s own join-our-network page, one insurer at a time. There is no shortcut and no directory that submits for you. Every application page and provider phone number on this site was read off the company’s own website, because a number that reaches member services will waste your morning.
Can I bill insurance before I am credentialed?
Not as an in-network provider, and billing before your contract’s start date comes back unpaid every time even after you are approved. Approved is not the same as live: every contract carries an effective date, and claims for visits dated before it are rejected. Get that date in writing.
Do I need a CAQH profile?
For most commercial payers, yes, and it has to be attested. An un-attested profile is the single most common reason an application stops moving, and nobody writes to tell you. CAQH now trades as DataSpring, though the login is still proview.caqh.org and payers still write “CAQH ProView” in their instructions. Re-attest every 120 days, or every 180 days in Illinois.
Where LogBlues fits, and where it does not
We do not credential anybody, and we would be careful with any software company that says it does. What no software can shorten is a payer deciding to accept a provider.
What it does today. Once you are in network and billing, the claim is built from the visit the provider already wrote, so nobody types it a second time. It is checked before it leaves for the things payers reject claims for. When the payer answers, the remittance is read back and matched to the claim it came from, and a denial arrives as a sentence and a job on somebody’s list with the appeal deadline on it — not a code to go and look up. There is a denial report by payer and by reason, so a problem that repeats gets fixed once.
What it does not do yet. Keeping your credentialing paperwork — the licences and certificates, the expiry warnings, the status of each application — is being built and is not in the app you can download today. We would rather say that than let you find out. When it ships, this page will say where it lives and what it does, in the same plain words as the rest.
Then the ordinary work: the claim is built from the visit the provider already wrote, checked before it leaves, and when the payer answers you get a sentence rather than a code to look up. See insurance and claims and billing.
Why a software company gave this away
Every other page on the internet that tells you this wants your email first, because the information is the product. For us it is not. We make practice software, and a clinic that knows how to get paid is a clinic that can use it. So this page stays free, with no sign-up and no email, for good.
And when your first contract goes live, this is the part we do: the claim built from the visit the provider already wrote, checked before it leaves, and the payer’s answer read back in plain words instead of a code to look up. One price for the whole practice, the front desk never counted as a seat, and Blues included on every plan.
Every URL, phone number and figure on this page was read off the organization’s own website on 7 September 2026. Every fee named on this page is charged by a government agency or an insurance company, never by LogBlues. This is a plain-words guide, not legal or billing advice. For anything out of the ordinary, ask somebody who does this for a living. If a number has moved, tell us and we will fix it.