Breaking down credentialing: What every therapist needs to know

Credentialing can feel like a daunting and never-ending process. If you’ve begun this as a practice owner or an independent therapist, you know how complex it can get. This guide aims to make credentialing a bit clearer and easier to grasp. We’ll break down why it matters, the common hurdles therapists face, how to get credentialed, and how to stay on top of it all. We’ll also share how tools and simple strategies can make the whole process a little smoother. 

Why credentialing matters 

Skipping or delaying credentialing can feel tempting, but it’s essential for a thriving, compliant practice. Here’s why:  

• Builds trust: Verifies your qualifications, reassuring clients, referral networks, and insurers.  

• Ensures payment: Lets you bill insurance, making therapy accessible to more clients.  

• Minimizes risks: Protects your practice by meeting professional standards and reducing legal issues.  

Credentialing is more than a task—it’s a foundation for success! 

Why credentialing feels so complicated 

If you’ve found yourself asking, “Why does this take so long?” or “Why is credentialing so frustrating?”, you’re not imagining it. Credentialing is a notoriously lengthy process with plenty of moving parts. Here’s why: 

• Credentialing requires thorough verification of work history, education, licenses, and more, often slowed by backlogs and delays.  

• Multiple stakeholders like insurance panels and hospital networks involve differing requirements, increasing chances of delays or miscommunication.  

• Even minor errors, like mismatched dates or incomplete profiles, can cause weeks or months of delays.  

• Lack of a universal system means navigating unique processes, forms, and timelines for each organization. 

How to get credentialed step by step 

While credentialing isn’t quick, having a clear roadmap can make it more manageable. Here’s what the process generally looks like: 

Step 1: Collect all necessary documents 

Make a checklist of what’s typically required, such as: 

• Your professional license(s) 

• Board certifications (if applicable) 

• National Provider Identifier (NPI) number 

• Updated resume or CV with no gaps in work history 

• Proof of malpractice insurance 

• Diplomas or transcripts (when requested) 

• References 

• Tax identification number (TIN) or EIN (if you’re operating under a business entity) 

Keep both digital and physical copies labeled clearly. 

Step 2: Submit your CAQH profile 

CAQH (Council for Affordable Quality Healthcare) simplifies healthcare paperwork by centralizing credentialing through CAQH ProView. This free, widely accepted platform lets therapists upload and manage their credentials, making it easy for insurance companies to verify information. Re-attestation every 90 days keeps profiles active. 

Some therapists find that CAQH ProView can be cumbersome to navigate, especially if you’re unfamiliar with the platform or need more flexibility for unique workflows. In these cases, exydoc offers a great alternative.  

exydoc’s provider data management system simplifies the entire credentialing process by handling everything from capturing provider data to managing payer rosters and expediting enrollment through delegated credentialing agreements. By using exydoc, you can actually replace steps 2-5 in this guide, as the platform takes care of submitting applications, verifying credentials, and managing communications with payers. It’s an efficient, all-in-one solution that eliminates duplicate data entry, integrates seamlessly with your practice’s needs, and reduces the administrative burden of credentialing. 

Step 3: Apply to insurance panels or organizations 

Decide which insurance companies or hospital networks you want to work with. Each will require either direct applications or, in some cases, will pull your info from CAQH. Some might request supplemental forms. Make sure to check their specific credentialing deadlines or opportunities, as some panels open enrollment only periodically. 

Step 4: Undergo primary source verification 

This is where insurance companies or networks verify all of your information. They’ll contact your licensing board, training institutions, and sometimes past employers. You won’t need to do anything here unless they request clarification or additional details. 

Step 5: Wait for committee review 

Credentialing committees at payer organizations review applications and decide whether to approve or deny them. This step can stretch the timeline, as committees may only meet monthly. 

Step 6: Finalize contracting 

Once your credentialing is approved, you’ll often need to sign a contract with the organization or insurance panel. Be sure to review terms, including reimbursement rates, and clarify your effective date (when you can start billing). 

Continuing credentialing and recredentialing

Getting credentialed is just the beginning. To maintain your credentials and keep billing insurance without interruptions, recredentialing and ongoing upkeep are necessary. Here’s what’s involved: 

Why it’s necessary 

Insurance companies and organizations require recredentialing every few years (typically 2-3). This ensures that your license, malpractice policies, and other qualifications are still valid. It’s also a way for them to ensure you’re staying compliant with updated regulations. 

How the process works 

1. Renew your licenses and certifications: Keep track of state license renewal dates and factor in the time needed to complete mandatory continuing education requirements. 
2. Provide updated documents: Insurance companies will ask for renewed malpractice insurance proof, updated CE certificates, and a re-attested CAQH profile. 
3. Verify work history and clean record: Organizations look for any malpractice claims or disciplinary actions since their last review. 
4. Submit to payer reviews: Recredentialing often follows a process similar to initial credentialing. Deadlines missed here can mean losing access to insurance networks, so planning ahead is critical. 

Tips to stay on top of it 

• Set calendar alerts for license renewals, malpractice insurance updates, and upcoming recredentialing deadlines. 

• Maintain a digital file with all your credentialing documents so it’s easy to provide updated versions when needed. 

• Use tracking tools, like credentialing management software, to avoid any lapses. 

Work smarter, not harder—with the right tools 

Using both exydoc and Ensora Health together helps simplify your therapy practice by combining powerful tools for credentialing, billing, and scheduling into a seamless workflow.  

exydoc handles credentialing, tracking licenses, managing payer enrollments, and expiring document reminders. It helps onboard new clinicians quickly, so your team is ready to work without delays. Ensora Health covers daily operations like scheduling, billing, charting, and client engagement. Together, they address key practice needs: 

• Credentialing supports smoother billing: Once your clinicians are credentialed through exydoc, they’ll be eligible to bill insurance, and you can manage those claims through Ensora Health’s billing features. 

• Reduced administrative headaches: Having exydoc take care of document management and deadlines means you don’t have to scramble to keep up with credentialing. Meanwhile, Ensora Health takes the pressure off your front desk by streamlining scheduling, notes, and billing. 

• Better compliance and oversight: exydoc’s notifications about expiring licenses or documents help keep your roster current, while Ensora Health’s reporting and management tools help monitor overall practice operations, so nothing slips through the cracks. 

• More time for what matters: By letting each tool handle its own part of the work, you free up hours that would otherwise go to admin tasks—so you and your team can focus on supporting clients. 

As an Ensora Marketplace partner, exydoc works alongside Ensora Health to simplify both credentialing and practice operations. If growth is on your horizon or you just want things to feel less stressful day-to-day, using both gives you peace of mind. You get the benefits of expert credentialing management and reliable, all-in-one practice software, all working to support you, your staff, and your clients. 

Final thoughts 

Credentialing can feel like an uphill battle, but it’s a crucial part of running your practice and serving your clients. By breaking the process down into clear steps and staying on top of renewals, you can avoid disruptions to your work. Automation tools and thoughtful organization can further ease the challenges, giving you more time to focus on what you do best—supporting your clients on their paths to healing. 

Take it one step at a time, and know that while it may feel overwhelming, it’s absolutely manageable with the right systems in place. Your hard work will pay off as you provide valuable care to your community with the confidence that everything is in order. 

If you found this guide to be helpful, take a look at our Marketplace partner, exydoc. While Ensora Health focuses on simplifying practice management with comprehensive software solutions, exydoc specializes in provider data management, credentialing, and enrollment. Their platform streamlines the credentialing process with features like license tracking, payer roster management, and delegated credentialing agreements, making it easier for therapists to navigate the complexities of credentialing and licensure.