Credentialing glossary.

A

Attestation

A formal confirmation that all information in your CAQH profile is current and accurate. Required every 120 days to keep your profile active.

C

CAQH

Council for Affordable Quality Healthcare. CAQH ProView is a free database where providers store their credentialing information. Most payers pull from CAQH instead of requiring separate applications.

Credentialing

The verification process where a payer confirms your education, training, licenses, and malpractice history before allowing you to join their provider panel.

E

Effective Date

The date your contract with a payer officially begins. You can only bill for services on or after this date.

EIN

Employer Identification Number. A federal tax ID for your business entity, used instead of your SSN on payer applications if you have an LLC or PLLC.

N

NPI Type 1

National Provider Identifier for individual providers. This is your personal identifier — it stays with you regardless of where you practice.

NPI Type 2

National Provider Identifier for organizations or group practices. Required if you bill under a group or LLC.

P

Paneling

The process of getting accepted onto an insurance company's provider panel so you can bill them for services.

PECOS

Provider Enrollment, Chain, and Ownership System. The CMS portal where you enroll as a Medicare provider.

Provider Panel

The network of approved providers that an insurance company contracts with. Being on the panel means you are in-network for that payer.

R

Re-credentialing

The periodic review process (typically every 2-3 years) where payers verify your credentials are still current. Missing deadlines can result in termination from the panel.

T

Taxonomy Code

A standardized code that classifies your provider type and specialty. Used on your NPI registration and payer applications.