Credentialing Audit

Credentialing Delays: Why They Happen and How to Prevent Them

Incomplete documents, inconsistent provider information and missed payer requests can hold up credentialing. Here's what the sources say.

3 min read

Published payer and CMS sources point to a few repeat causes: incomplete or outdated documents and CAQH profiles, inconsistent provider or practice information, and missed payer requests or follow-ups.

Each section below names the source behind the cause, then the habit that addresses it.

Why credentialing applications get delayed

Incomplete or outdated documents/CAQH

Two payers name the CAQH Provider Data Portal (formerly ProView) profile directly. UnitedHealthcare asks providers to complete a CAQH application and authorize UnitedHealthcare to access it. Cigna asks that the profile show one of two statuses: Initial Profile Complete or Re-attestation.

UnitedHealthcare says a complete, current CAQH Provider Data Portal profile can help avoid delays.

Profiles also need regular attestation. DataSpring, which operates the CAQH Provider Data Portal, says that if providers don't attest within the required timeframe, their status changes to Expired. For how attestation works, see our CAQH attestation guide.

Inconsistent provider or practice information

UnitedHealthcare asks you to complete a CAQH application and authorize UnitedHealthcare to access it. Our posts on NPI Type 1 vs Type 2 and PECOS vs NPPES explain which identifiers sit where. If you also enroll in Medicare, the callout below covers where CMS requires your details to match exactly.

Missed payer requests or follow-ups

Payers may come back with questions. Cigna says it requests any missing documentation or application information, and if it does not receive it, it sends an email notification that it closed the application.

How to prevent credentialing delays

For hands-on support, see our help with provider enrollment.

Complete every section before you submit

Check that the CAQH application is complete and that you've authorized each payer to access it. Confirm the profile shows a status the payer accepts, such as Initial Profile Complete or Re-attestation for Cigna. Our provider credentialing checklist lists the documents to gather.

Keep your CAQH Provider Data Portal (formerly ProView) profile current and authorized

Confirm your status is one the payer accepts. See the CAQH attestation guide for the cycle.

Keep your records matching across systems

Keep your CAQH profile attested. If you also enroll in Medicare, our guide to updating PECOS practice information covers that side.

Answer payer requests and follow up

Watch for payer emails and send missing documents or information when asked. Cigna says it closes applications when requested information is not received.

If you also enroll in Medicare

For Medicare enrollment:

  • CMS's Form CMS-855I lists steps to avoid enrollment delays, including completing all required sections, making sure the legal business name in section 4 matches your tax documents, and signing and dating section 15. (Read November 5, 2026.)
  • CMS's CMS-855I says your name, SSN, LBN, TIN and NPI must match exactly in both PECOS and NPPES. (Read November 5, 2026.)
  • CMS's NPI fact sheet says updating your NPI record in NPPES doesn't automatically update your Medicare enrollment information. (Read November 5, 2026.)
  • In PECOS, CMS says you can review and update your information and report changes to your enrollment record. (Read November 5, 2026.)

What you can and can't control

On your side: keeping your CAQH profile attested, authorized and at a status the payer accepts, and sending missing information when a payer asks. Approval, effective dates, and processing timelines are outside our control. For what affects timing, see how long credentialing takes.

FAQs

Why is my credentialing application taking so long?

Published payer and CMS sources point to incomplete or outdated documents/CAQH, inconsistent provider or practice information, and missed payer requests or follow-ups.

Can an expired CAQH profile hold up credentialing?

DataSpring says your status changes to Expired if you don't attest within the required timeframe, and Cigna asks for a status of Initial Profile Complete or Re-attestation.

What happens if I miss a payer's request for information?

Cigna says that if it does not receive missing information, it emails you that it closed your application.

Not sure where your application is stuck?

A credentialing audit is a preliminary review of where your credentialing stands. You receive a written report of the current issues we find with your credentialing.

Approval, effective dates, and processing timelines are outside our control.

Sources