Why Credentialing Takes So Long

Credentialing is the process by which a payor verifies that a provider meets its standards for network participation. For ABA practices, credentialing involves both the organization (the billing entity) and individual providers (BCBAs and sometimes BCaBAs).

The process is notoriously slow — typically 90–120 days for commercial payors and up to 180 days for some Medicaid programs. Understanding why it takes so long helps you plan accordingly.

Why it's slow:

  • Payors verify credentials through primary source verification (contacting BACB, state licensing boards, malpractice insurers directly)
  • Many payors use delegated credentialing vendors (CAQH, Navicure) that add processing time
  • Payors have credentialing committees that meet monthly or quarterly
  • Incomplete applications are returned and restart the clock

    • The CAQH Profile: Your Credentialing Foundation

    CAQH ProView is the universal credentialing database used by most commercial payors. Maintaining an accurate, complete CAQH profile is the single most important step in streamlining the credentialing process.

    CAQH Profile Requirements

  • Personal and professional information
  • Education and training history
  • Board certifications (BCBA certification from BACB)
  • State licensure (if applicable in your state)
  • Malpractice insurance information
  • Work history (past 10 years)
  • Hospital affiliations (if any)
  • DEA registration (if applicable)
  • Medicare/Medicaid enrollment information

    • Critical: Re-attest your CAQH profile every 120 days. Payors will not process credentialing applications for providers with expired CAQH profiles.

    Credentialing Timeline by Payor

    PayorTypical TimelineNotes
    Aetna90–120 daysUses CAQH; committee review monthly
    Anthem90–120 daysUses CAQH; state-specific variations
    Cigna/Evernorth90–120 daysBehavioral health credentialed separately
    UHC/Optum90–120 daysOptum credentialing for behavioral health
    Humana90–120 daysUses CAQH
    Medicaid (varies)120–180 daysState-specific process; often slower than commercial

    The Credentialing Process Step by Step

    Step 1: Obtain an NPI (if you don't have one)

  • Individual NPI (Type 1) for each BCBA
  • Organizational NPI (Type 2) for the billing entity
  • Apply at nppes.cms.hhs.gov — free and typically processed within 10 business days

    • Step 2: Complete or Update Your CAQH Profile

  • Create a CAQH ProView account at proview.caqh.org
  • Complete all required sections
  • Upload all required documents (license, malpractice certificate, BCBA certificate)
  • Authorize payors to access your profile

    • Step 3: Submit Payor-Specific Applications

    Most payors require a payor-specific application in addition to the CAQH profile. Submit applications to:

  • The payor's provider enrollment department (online portal or paper application)
  • Include your CAQH ID on all applications

    • Step 4: Follow Up Regularly

    Credentialing applications can sit in queues for weeks without action. Follow up with each payor every 2–3 weeks to check status.

    Step 5: Obtain a Participation Agreement

    Once credentialing is approved, the payor will send a participation agreement (contract) for your signature. Review the fee schedule carefully before signing.

    Medicaid Credentialing

    Medicaid credentialing is separate from commercial payor credentialing and is managed by the state Medicaid agency or its managed care organizations.

    Key differences from commercial credentialing:

  • Must enroll as a Medicaid provider with the state agency (separate from MCO credentialing)
  • MCO credentialing is required in addition to state enrollment for managed care clients
  • Some states require ABA-specific provider qualifications beyond BCBA certification

    • Medicaid enrollment resources:

  • State Medicaid agency provider enrollment portal (varies by state)
  • PECOS (Provider Enrollment, Chain and Ownership System) for Medicare enrollment (required for some Medicaid programs)

    • Avoiding Common Credentialing Delays

    Delay 1: Expired malpractice insurance. Payors will not process applications with expired malpractice certificates. Renew annually and update CAQH immediately.

    Delay 2: Inconsistent information across applications. Your name, address, NPI, and tax ID must be identical across all applications and your CAQH profile. Inconsistencies trigger manual review.

    Delay 3: Missing primary source verification. Payors verify your BCBA certification directly with BACB. Ensure your BACB profile is current and your certification is in good standing.

    Delay 4: Not following up. Applications that sit without follow-up can expire or be lost in the queue. Follow up every 2–3 weeks.