Medical Credentialing Services in Arizona

Why is Medical Credentialing Essential to Start Your Practice in 2026?

Credentialing in medical billing is the process of verifying healthcare providers’ qualifications, licenses, certifications, education, training, and clinical experience to ensure they are eligible to provide medical services and submit claims for reimbursement. This step is crucial for healthcare organizations and insurance companies to ensure providers meet the standards for patient care and payment. The process often involves checking the provider’s educational background, medical licenses, board certifications, malpractice history, and professional references. Credentialing helps prevent claim denials and ensures compliance with billing regulations.

How Do You Get Credentialed with Medicaid?

To get credentialed with Medicaid, follow these steps:

1. Eligibility Check: Ensure you meet the specific Medicaid requirements, including a valid professional license, National Provider Identifier (NPI), and Tax Identification Number (TIN).

2. Complete the Application: Fill out the Medicaid provider enrollment application specific to your state, which includes details about your qualifications and services.

3. Submit Required Documents: Provide all necessary documents, including your license, certifications, malpractice insurance, and any state-specific forms.

4. Background Check: Complete background checks or fingerprinting as required by the state.

5. Site Visit: Some states may require an on-site inspection of your practice.

6. Approval Process: Apply via your state’s Medicaid portal or CMS PECOS system. After approval, you’ll receive a Medicaid provider ID and can begin billing for services.

Each state may have unique requirements, so always verify the steps with your state’s Medicaid office.

What is the Difference Between CAQH and State Medicaid Credentialing?

• The key differences between CAQH and state Medicaid credentialing are:

  • CAQH (Council for Affordable Quality Healthcare) is a centralized, standardized electronic database where healthcare providers enter and maintain their professional credentials in one profile. This profile is then accessed by multiple insurance companies, including many Medicaid programs, to verify qualifications and streamline credentialing. CAQH facilitates data submission and primary source verification but does not itself credential or enroll providers.​

  • State Medicaid Credentialing is a separate process where providers apply directly to their state’s Medicaid program to verify eligibility to participate in Medicaid and bill Medicaid patients. This involves submitting applications through state Medicaid portals, meeting state-specific requirements, completing additional documentation beyond CAQH, and often undergoing background checks or fingerprinting. Each state may have unique processes and forms for Medicaid enrollment that are not covered by CAQH.​

  • Process Scope: CAQH serves as a data repository used by many private insurers and some Medicaid programs for credentialing verification. State Medicaid credentialing includes the final enrollment and contracting step that legally authorizes providers to deliver services to Medicaid beneficiaries in that state.

  • Credentialing vs. Enrollment: CAQH profiles support credentialing (verification of qualifications), but Medicaid credentialing often includes enrollment (contracting and authorization) specific to that state Medicaid program. Medicaid credentialing usually also requires separate state-level applications besides CAQH.​

  • Revalidation and Updates: Providers must update and re-attest their CAQH profiles quarterly, which will broadly affect network participation. Medicaid re-enrollment and recertification occur per state regulations, typically every few years.

Can CAQH Submission Speed Up Medicaid Enrollment?

Yes, submitting a CAQH profile can speed up Medicaid enrollment by providing a centralized, verified repository of provider credentials that many state Medicaid agencies and managed care organizations (MCOs) access directly, reducing manual data entry and verification time.​

Key Benefits

• Streamlined Data Access: Medicaid programs use CAQH ProView to pull professional data (licenses, education, malpractice info), cutting enrollment lead times from months to weeks in participating states; over 1.4 million providers use it for this purpose.​

• Higher Accuracy and Automation: CAQH achieves 98.5% primary source verification accuracy, minimizing rejections and follow-ups that delay Medicaid approvals.​

• Cost and Time Savings: Providers enter data once for multiple payers, potentially saving Medicaid agencies $4.8 billion annually through efficiency; processing can be shortened by 50% or more when CAQH is complete and attested every 120 days.

Which States Accept CAQH for Medicaid Credentialing?

• CAQH ProView is accepted or supported for Medicaid credentialing in all 50 states and the District of Columbia, as it provides a standardized application modified for state-specific fields, even where unique forms exist. However, 12 states and DC have formally adopted CAQH as their mandated or designated provider credentialing application, while 25 states voluntarily deploy it.​

  Mandated/Adopted States (12 + DC)

  These states require or officially designate CAQH for credentialing applications:

  • Indiana

  • Kansas

  • Kentucky

  • Louisiana

  • Maryland

  • Missouri

  • New Jersey

  • New Mexico

  • Ohio

  • Rhode Island

  • Tennessee

  • Vermont

  • District of Columbia​

  Voluntary Deployment (25 States)

  An additional 25 states voluntarily use CAQH for Medicaid processes, including integration with portals for verification and enrollment efficiency. Examples include California (Medi-Cal requires CAQH participation), Delaware, Florida, and many others; exact lists evolve but cover nationwide access.​

  Usage Notes

  All states benefit from CAQH’s data for streamlining Medicaid enrollment, but providers must still submit via state portals (e.g., PECOS-linked) and meet additional requirements like background checks. Check your state’s Medicaid website for current integration.​