Credentialing: status, timeline, what to expect

Credentialing is how a provider gets approved by a payer to see that payer's clients and be reimbursed. It runs in the background while you get set up, but the timeline matters — in most cases a provider can't bill (and sometimes can't see clients) for a payer until credentialing is complete. This article explains what credentialing involves, how long it takes, and how to check where a provider stands.

Payer-specific rules vary. For the TRICARE process in depth, see "Understanding the TRICARE Credentialing Process with Alpaca Health."

How credentialing starts

To begin credentialing for a provider, they must complete the Alpaca Health credentialing intake form. Once it's submitted, Alpaca's credentialing team initiates the process. If a provider doesn't appear in the credentialing system at all, it's almost always because this form hasn't been completed yet — that's the first thing to check.

What's typically required first

Before an application can go to a payer, these prerequisites usually need to be in place. Gaps here are the number-one cause of delay, so get them done early:

• Background check — a recent one is required; the credentialing team can send a link if you don't have one on file.

• CAQH profile — updated and attested. See "Create a CAQH Profile (Provider Data Portal)."

• CPR/BLS certification — valid and current.

• Active BACB status — the provider's BACB certification must be active.

• NPI number (for RBTs) — RBTs credentialing with some payers need an NPI. See "How to Get an NPI."

• RBT taxonomy in NPPES (for RBTs) — add taxonomy code 106S00000X to the NPPES profile where the payer requires it.

How long it takes

Once all prerequisites are done and the application is submitted, processing time depends on the payer. As a benchmark, TRICARE is typically about 14 days (2 weeks) after submission. The clock that matters is the one that starts after submission — delays in finishing prerequisites (a pending background check, an un-attested CAQH profile) extend the overall timeline before submission even happens.

Some payers have extra waiting rules. For example, TRICARE requires waiting 10 business days after NPI issuance before RBT credentialing can proceed. Plan around these when you're estimating a start date.

Can a provider see clients before it's done?

Generally, no — and this differs by payer, so confirm before scheduling:

• TRICARE: RBTs must be individually credentialed before seeing TRICARE clients. Services should be rendered within the approved authorization period. TRICARE may backdate billing to the application submission date, but this is not guaranteed — wait for official approval unless Alpaca's team advises otherwise.

• HMSA: RBTs are not required to be individually credentialed; an active RBT credential is enough to work with HMSA clients.

When in doubt, treat "not yet credentialed" as "not yet able to bill" and check with the credentialing team.

How to check credentialing status

Track a provider's application through the Alpaca Health credentialing tracking link provided by the credentialing team. If you haven't received your link, email credentialing@alpacahealth.io and they'll provide it.

For the fastest response on a status question, email credentialing@alpacahealth.io directly rather than general support.

Common reasons credentialing stalls

For anything not covered here, reach the credentialing team at credentialing@alpacahealth.io.