Getting a provider credentialed with a payer is not a one-time task. After a provider joins a network, payers periodically review the provider's qualifications and information again, and Medicare and Medicaid run their own enrollment revalidation cycles. Practices that track these cycles are better placed to respond on time and keep payer records accurate.
What is provider recredentialing?
Provider recredentialing is a payer's periodic review of a participating provider's qualifications and information. It repeats much of the verification done during initial credentialing, confirming that licenses, coverage, and other records are still current, and it gives the payer a point to review the provider's continued participation in its network.
Initial credentialing happens when a provider first applies to join a payer's network. Recredentialing applies to providers who already participate. Each payer runs its own process, so a provider who participates with several payers can have several recredentialing timelines at once.
How often does provider recredentialing happen?
There is no single schedule that applies to every payer. Many health plans align their credentialing programs with standards from the National Committee for Quality Assurance (NCQA), and plans that follow those standards commonly recredential participating practitioners at least every 36 months. For example, Colorado Access's 2026 credentialing policy describes recredentialing at least every 36 months to meet NCQA standards, and BlueCross BlueShield of South Carolina states that recredentialing for participating practitioners occurs every three years.
Other payers, state programs, and contracts can set different timing, and a payer may ask for updated information between cycles. The most reliable guide is each payer's own notice and the current requirements in its provider manual or agreement. Track due dates payer by payer rather than assuming one interval applies everywhere.
Recredentialing vs. CAQH re-attestation
Many payers use CAQH profile information when they credential and recredential providers, but keeping a CAQH profile current is a separate task. Re-attestation confirms that the information in the provider's profile is accurate, and it runs on its own, much shorter schedule: currently every 120 days for most providers, or every 180 days for providers in Illinois.
A current, attested profile can support recredentialing, but it does not replace a payer's own review or guarantee continued participation. Our CAQH profile guide covers updates and re-attestation in more detail.
Recredentialing vs. Medicare and Medicaid revalidation
Medicare and Medicaid have their own enrollment revalidation requirements. These are separate from a commercial payer's recredentialing, and completing one does not satisfy the others.
Medicare revalidation
Under federal regulation (42 CFR 424.515), most Medicare providers and suppliers must resubmit and recertify their enrollment information every five years. DMEPOS suppliers follow a separate three-year cycle. CMS can also require revalidation outside the routine cycle, and it contacts providers when it does.
Medicaid revalidation
Federal rules (42 CFR 455.414) require each state Medicaid agency to revalidate the enrollment of all providers at least every five years. States can set shorter timeframes, and Medicaid managed care plans may run their own credentialing, so requirements should be confirmed with each state program and plan.
What information may be reviewed again?
Requirements vary by payer, but recredentialing commonly revisits:
- Professional licenses in each state where the provider practices
- DEA or state controlled substance registration, where applicable
- Professional liability coverage and malpractice history since the last review
- Federal sanctions and exclusions
- Hospital privileges or admitting arrangements, where the payer requires them
- A signed attestation and release, along with current practice locations and contact details
- Quality information, such as complaints, where the payer tracks it
What can cause recredentialing delays?
Most delays come from preventable administrative issues:
- Information that no longer matches across payer records, the CAQH profile, and practice systems
- Missing or expired documents, such as a license or liability certificate
- Payer notices sent to an outdated address or contact
- Applications submitted incomplete or without required signatures
- Late responses to requests for additional information
Some payers handle lapses strictly. BlueCross BlueShield of South Carolina, for example, states that a new enrollment application is required if a provider's recredentialing is past due or due within 60 days.
A practical recredentialing tracking checklist
- Keep one record of every payer, provider, and location, with recredentialing and revalidation due dates
- Re-attest the CAQH profile on schedule, and update it whenever information changes
- Track license, DEA, and liability coverage expiration dates
- Watch for payer notices, and keep the contact details payers use current
- Assign an internal owner for each provider's credentialing file
- Record submission dates, reference numbers, payer requests, and follow-up
Our provider credentialing readiness checklist covers the records worth having ready before any application or review.
When outside credentialing support may help
Recredentialing is ongoing administrative work, and it grows with every provider, payer, and location a practice adds. All State RCM can coordinate recredentialing alongside initial credentialing, CAQH maintenance, and payer follow-up within an agreed scope, while payers make their own participation decisions and set their own timelines. Learn more about our provider credentialing services.
Frequently asked questions
What is provider recredentialing?
It is a payer's periodic review of a participating provider's qualifications and information, carried out after initial credentialing to confirm that records are still current.
How often do providers need to be recredentialed?
It depends on the payer. Health plans that follow NCQA standards commonly recredential at least every 36 months, but schedules vary, so follow each payer's notices and current requirements.
Is recredentialing the same as CAQH re-attestation?
No. Re-attestation confirms that a CAQH profile is accurate and currently recurs every 120 days for most providers. Recredentialing is a payer's own review of the provider.
Is Medicare revalidation the same as payer recredentialing?
No. Medicare revalidation is a federal enrollment requirement, generally every five years for most providers and suppliers. It runs separately from any commercial payer's recredentialing.
What happens if a payer requests updated credentialing information?
Send the requested information by the payer's deadline and keep a record of what was sent and when. Missed requests can delay the review, and some payers require a new application when recredentialing lapses.
Can a credentialing service help track recredentialing?
Yes. A credentialing service can track due dates, prepare submissions, and follow up with payers within an agreed scope. It cannot control payer decisions or timelines.
