Calculator
Credentialing timeline planner
Credentialing runs on several clocks at once, and only some of them are published. Enter a start date and the enrollments you need; the planner puts the steps in order and dates only the ones whose timing CMS, a federal rule or CAQH publishes.
Part of Remitwright's free medical billing calculators, each with its formula shown.
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Result
Your credentialing checklist
Enter a start date, choose at least one enrollment, then press Plan the steps.
| When | Step |
|---|
Each date comes from the dates you entered and the CMS, federal or CAQH rule footnoted beside it; none is a Remitwright commitment. Steps without a date are timed by the payer, the state or the broker, and no figure is shown where no official source publishes one.
How this is calculated
Medicare filing date = the later of your start date and (first date of service − 60 days)MAC processing standards = filing date + 15, 50 or 85 calendar days, by routeEarliest Medicare effective date = the later of the filing date and the first date of serviceRetrospective billing window opens = effective date − 30 daysNext CAQH attestation = attestation date + 120 daysEvery other step = your start date, or no date where the state, plan or broker sets its own timing
Benchmark and reference sources: Medicare Enrollment for Providers and Suppliers, Centers for Medicare & Medicaid Services; Medicare Program Integrity Manual, Chapter 10: Medicare Enrollment (Rev. 13717), sections 10.1.4, 10.4.1.4.2, 10.4.1.4.3 and 10.5, Centers for Medicare & Medicaid Services; 42 CFR 424.520, Effective date of Medicare billing privileges, Code of Federal Regulations, via the Legal Information Institute, Cornell Law School; 42 CFR 424.521, Request for payment by physicians, non-physician practitioners and other suppliers, Code of Federal Regulations, via the Legal Information Institute, Cornell Law School; Revalidations, Centers for Medicare & Medicaid Services; 42 CFR 455.414, Revalidation of enrollment, Code of Federal Regulations, via the Legal Information Institute, Cornell Law School; SMD 23-006, Assurance of Transportation: A Medicaid Transportation Coverage Guide, Centers for Medicare & Medicaid Services; Clinicians and Office Staff: the CAQH Provider Data Portal, DataSpring (CAQH); Medicaid Non-Emergency Medical Transportation Booklet for Providers, Centers for Medicare & Medicaid Services, Medicaid Program Integrity Education; CMCS Informational Bulletin: Medicaid Coverage of Certain Medical Transportation under the Consolidated Appropriations Act, 2021, Medicaid.gov, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services; 45 CFR 162.410, Implementation specifications: health care providers, Code of Federal Regulations, via the Legal Information Institute, Cornell Law School.
Benchmarks are industry figures from the sources listed; they are not Remitwright results.
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Why most steps carry no date
Medicare is the one payer on this list whose contractor timing CMS publishes: the Program Integrity Manual sets how fast a MAC processes an application and how long you have to answer its questions.2 The effective date and the 30-day lookback come from federal regulation.34
State Medicaid agencies must screen the providers they enroll7 and revalidate each enrollment at least every five years,6 but each state runs its own queue. Commercial plans and NEMT brokers set their own review steps, so the planner lists those steps in order and leaves the date to the plan.
What stalls each step, payer by payer, is in the provider credentialing and enrollment guide. With credentialing services, a dedicated biller prepares each application and tracks it to an effective date, remotely. Transportation companies have NEMT credentialing for the state and broker files.
How it is worked out
The formula
- 01
Medicare filing date = the later of your start date and (first date of service − 60 days) - 02
MAC processing standards = filing date + 15, 50 or 85 calendar days, by route - 03
Earliest Medicare effective date = the later of the filing date and the first date of service - 04
Retrospective billing window opens = effective date − 30 days - 05
Next CAQH attestation = attestation date + 120 days - 06
Every other step = your start date, or no date where the state, plan or broker sets its own timing
Assumptions and limits
- Dates are calendar days counted from the dates you enter. A date marks the earliest point for a step, or a processing standard CMS sets for its contractors; it is not a decision date any payer has promised.
- Medicare: the MAC may return an application it receives more than 60 days before the effective date listed on it, so when you give a first date of service the planner holds the filing until 60 days before it.
- The MAC standards are measured on the contractor, not owed to you, and the Program Integrity Manual stops the clock in listed cases, such as while fingerprint results are pending.
- The effective date rule and the 30-day retrospective window cover physicians, non-physician practitioners and their groups, among other supplier types the regulation lists. The window applies only where circumstances kept the provider from enrolling first.
- Each state, plan and broker sets its own processing time, so their decision steps carry no date. Your state Medicaid manual or the plan's provider guide may publish one for your provider type.
- NEMT: the state decides whether the company, each driver or both enroll, and the contract with the broker or plan that manages trips has to be in place before the first trip.
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