Recredentialing: the three-year cycle and the 120-day one

In this article▾

1. What is provider recredentialing?
2. How often do providers need to be recredentialed?
3. Recredentialing vs. CAQH re-attestation: What's the difference?
4. What happens if you miss a recredentialing deadline?
5. The provider recredentialing process: Step by step
6. How to build a recredentialing deadline tracker
7. Common recredentialing mistakes to avoid
8. Frequently asked questions about recredentialing
9. Final takeaway
10. Sources
11. Related reading

A missed recredentialing deadline can put a behavioral health provider's network participation at risk. Depending on the payer's rules and the circumstances, a provider may be removed from a panel or lose active network status, creating billing disruptions and potentially denied claims until the issue is resolved. For practice managers and credentialing staff, recredentialing is not simply an occasional paperwork exercise. It is an ongoing operational responsibility.

Recredentialing is the periodic review of an already credentialed provider to confirm that they continue to meet a health plan's participation requirements. Under NCQA credentialing standards, the standard recredentialing cycle is every three years. That is a different deadline from CAQH re-attestation, which the CAQH Provider Data Portal user guide puts at every 120 days, or 180 days for Illinois providers.

These are separate deadlines serving different purposes. Recredentialing is a broader review of a provider's qualifications and continued eligibility. CAQH re-attestation confirms that the information in the provider's profile remains accurate and current.

This guide explains how recredentialing works, what can happen when deadlines are missed, and how behavioral health practices can build a reliable system for keeping every provider's credentials current. For the profile those reviews draw on, start with our guide to CAQH credentialing.

What is provider recredentialing?

Provider recredentialing is the recurring process a health plan or credentialing organization uses to reassess a provider who has already been approved to participate in a network.

Initial credentialing establishes whether a provider meets the requirements to join a network. Recredentialing checks whether the provider continues to meet those requirements over time.

The review may include verification of:

• Current professional licenses and certifications.
• Education, training, and relevant professional qualifications.
• Work history and other required application information.
• Professional liability insurance.
• Disciplinary actions, sanctions, and other relevant disclosures.
• Malpractice history and other information required by the payer.
• Current practice locations, specialties, and contact information.
• Other eligibility criteria specified by the health plan or applicable credentialing standards.

The exact requirements depend on the payer, provider type, applicable regulations, and credentialing policies. A health plan may request an updated application, supporting documents, authorizations, or other information before completing its review.

NCQA's credentialing framework includes verification of practitioner credentials, review of credentialing decisions, and ongoing monitoring between recredentialing cycles. The purpose is to help maintain accurate provider networks and ensure that participating professionals continue to meet applicable qualifications.

Sources: NCQA Credentialing and NCQA's explanation of credentialing standards.

How often do providers need to be recredentialed?

The interval depends on the payer and the requirements governing the provider's network participation. Two timelines are particularly important for practice managers: the three-year recredentialing cycle and the much shorter CAQH re-attestation cycle.

The standard three-year recredentialing cycle

NCQA requires recredentialing every three years under its credentialing standards. Health plans and credentialing organizations subject to applicable NCQA requirements use this cycle to reassess participating practitioners.

For behavioral health practices, the important operational point is that a three-year cycle does not mean staff can ignore credentialing records for three years. Licenses, liability insurance, provider information, and other requirements may need attention much sooner.

Do not assume that every payer uses the same schedule. Verify the recredentialing interval in each payer's provider manual, participation agreement, or credentialing correspondence. State requirements and payer-specific policies may also affect the process.

CAQH re-attestation: Every 120 days, in most states

CAQH Provider Data Portal, formerly known as CAQH ProView, allows participating providers to maintain credentialing information that authorized health plans can access. CAQH itself has rebranded to DataSpring and caqh.org now redirects to dataspring.com, but the provider-facing product kept its name, so payer instructions referring to the CAQH Provider Data Portal are current.

Providers generally must re-attest their CAQH profiles every 120 days. For providers whose primary practice state is Illinois, the interval is 180 days. Both figures are stated in the CAQH Provider Data Portal user guide, which says re-attestation is required every 120 days, 180 days for Illinois providers.

That said, the due date shown on your own profile is the one that governs. If it disagrees with the interval you expected, work to the profile.

Re-attestation confirms that the information in the profile is accurate. It does not replace a payer's recredentialing application, credential verification, or any separate network review.

Sources: CAQH Provider Data Portal user guide

Recredentialing vs. CAQH re-attestation: What's the difference?

This distinction is one of the most important parts of credentialing deadline management.

Consider a clinician whose last recredentialing review was completed in March 2025. If the payer follows a three-year cycle, the next review may be due around March 2028, subject to the payer's actual schedule and instructions.

That same clinician will need to re-attest their CAQH profile roughly nine times before March 2028. Waiting until the next recredentialing review to update CAQH would leave the profile overdue for most of the gap.

For the full CAQH workflow, see Supa's guide to CAQH attestation, and the pillar guide to CAQH credentialing for how the profile is used by payers in the first place.

What happens if you miss a recredentialing deadline?

The consequences depend on the payer's policies, the status of the application, and whether the provider's participation has already been affected. A missed deadline should be treated as an urgent operational issue rather than an administrative reminder that can wait.

Possible consequences include:

1. Network participation may be suspended or terminated

A payer may place a provider's participation at risk if required recredentialing information is not received or the review is not completed within the applicable timeframe. The payer's process may involve notices, requests for missing information, or termination procedures.

Do not assume that a provider remains active simply because they were previously credentialed. Confirm their current status with the payer.

2. Claims may be denied or payment may be disrupted

If the payer terminates or deactivates network participation, claims submitted under the affected arrangement may be denied or payment may be interrupted. The impact depends on the payer's contract, the provider's status, the dates of service, and applicable claims rules. A credentialing lapse tends to surface as a rising denial rate on one clinician before anyone connects it to a missed date.

If participation has lapsed, ask the payer how the interruption affects services already delivered, pending claims, and future dates of service. Do not assume that reinstatement will be retroactive.

3. Reinstatement may require additional work

Depending on the payer's rules and how long the deadline has been missed, the provider may need to submit outstanding documents, complete a new review, or follow a reinstatement or reapplication process.

The practice may also need to update its billing team, review affected claims, and verify when the provider can resume in-network billing.

4. Patient access and practice operations may be affected

An inactive provider may no longer appear as participating in the relevant network. This can create confusion for patients, disrupt appointment planning, and require the practice to explain changes in coverage or billing arrangements. See in-network vs. out-of-network for how to handle the conversation and the patient's financial responsibility.

The best response is prevention: track the deadline, start early, and resolve requests before the payer's cutoff date.

The provider recredentialing process: Step by step

Payer procedures differ, but practice managers can use the following workflow to coordinate most recredentialing cycles.

Step 1: Identify the due date and requirements

Start by reviewing the payer's notice, provider portal, participation agreement, or credentialing policy.

Record:

• The recredentialing due date.
• The payer's submission deadline.
• The documents required.
• Whether a new application or attestation is needed.
• How the payer accepts supporting information.
• The contact details for credentialing questions.

Distinguish the date the payer needs the application from the date the review must be completed. If either is unclear, confirm it with the payer.

Step 2: Notify the provider and assign an owner

Assign a named credentialing coordinator to manage the process. Notify the clinician early and explain which information or documents they must provide.

For group practices, define responsibilities clearly:

• The clinician supplies accurate personal and professional information.
• The credentialing coordinator monitors deadlines and assembles the submission.
• The practice manager resolves organizational or contracting questions.
• The billing team confirms network status and flags any interruption that could affect claims.

A shared process prevents the application from depending on one person's memory or inbox.

Step 3: Review CAQH and supporting documents

Check whether the provider's CAQH profile is complete, current, and authorized for the relevant payer to access.

Review license expiration dates, liability insurance, practice locations, work history, and any other records required by the payer. Update information that has changed since the previous credentialing review.

Remember that completing CAQH re-attestation does not necessarily complete recredentialing. If the payer requests a separate application or documents, those requirements still need to be fulfilled.

Step 4: Complete the payer's recredentialing application

Follow the payer's instructions. Depending on the plan, this may involve updating an existing application, completing a recredentialing form, responding to an electronic request, or submitting additional documents through a portal.

Before submission, check that:

• The provider's name and identifiers are correct.
• Licenses and insurance records are current.
• Practice addresses and specialties are accurate.
• Required disclosures are complete.
• Supporting documents are legible and included.
• The application has been signed or attested where required.

Retain a copy of the submission and record its confirmation number or reference.

Step 5: Track outstanding requests and review status

Submitting the application is not the same as completing the review. Monitor the payer's portal and correspondence for missing information, verification issues, or additional requirements.

If the application stalls, ask the payer:

• Has the application been received and marked complete?
• Is any information still outstanding?
• Is the application under review?
• Is a credentialing committee decision or other approval pending?
• Will the current participation status be affected if the review is not completed by the deadline?

Document the response and assign the next action to a named staff member.

Step 6: Confirm completion and update the tracker

Once the payer confirms the review is complete, record the outcome and the next expected recredentialing date based on the payer's instructions.

Also verify that the provider's network status remains active and that no separate contracting or enrollment step remains outstanding.

Update your CAQH reminder separately. A completed recredentialing cycle does not reset or eliminate CAQH's independent re-attestation requirements.

How to build a recredentialing deadline tracker

A reliable tracker is more useful than a calendar reminder alone because it records both the deadline and the work required to meet it.

For every provider and payer combination, capture:

For group practices, track each provider separately for each payer. One clinician may be due for recredentialing with Aetna while another is waiting on Optum, Cigna or a Blue Cross Blue Shield plan. A single group-level date conceals those differences, and the cycles do not align.

Recommended reminder cadence

Use the payer's actual deadline to create reminders well in advance. The following is a practical internal schedule, not a universal payer requirement.

If the payer requires an earlier submission, follow that requirement instead. The objective is to finish the work before the deadline, not to submit on the last permissible day.

Common recredentialing mistakes to avoid

Treating CAQH attestation as recredentialing

These are separate processes. A current CAQH profile does not prove that the payer has completed its recredentialing review, in the same way that credentialing approval is not a contract.

Relying only on payer reminders

Notices can be overlooked, sent to outdated contacts, or routed to the wrong person. Maintain an internal tracker even when the payer sends reminders.

Starting too late

Missing insurance certificates, expired licenses, and slow responses from providers can delay a submission. Start early enough to resolve problems before the payer's deadline.

Tracking only the clinician, not the payer

A clinician may participate in several networks with different deadlines. Track each provider-payer combination individually.

Failing to verify completion

A submitted form is not confirmation that the review is complete. Record the payer's completion notice or otherwise verify the provider's current status.

Forgetting to update CAQH between cycles

Provider information can change long before the next recredentialing date. Maintain CAQH and other records continuously rather than waiting for the next full review.

Frequently asked questions about recredentialing

What is recredentialing in healthcare?

Recredentialing is the periodic review of an already credentialed provider to confirm that they continue to meet a health plan's participation requirements. It may involve checking licenses, professional qualifications, liability coverage, practice information, disclosures, and other required records.

How often does recredentialing happen?

NCQA credentialing standards use a three-year recredentialing cycle. However, the actual schedule and submission requirements should be confirmed with each payer because payer policies and applicable requirements can vary.

Is recredentialing the same as CAQH re-attestation?

No. Recredentialing is the payer's periodic review of a provider's continued eligibility. CAQH re-attestation confirms that the information in the CAQH profile remains accurate. CAQH re-attestation is generally required every 120 days, or 180 days for providers whose primary practice state is Illinois. Completing one does not replace the other.

What happens if a provider misses recredentialing?

Depending on the payer's policies and the provider's status, missing a deadline can put network participation at risk and may result in termination or other restrictions. Claims may be denied or payment disrupted if the provider is no longer active under the applicable agreement. Contact the payer immediately to confirm status, outstanding requirements, and the process for reinstatement.

Can a provider continue seeing patients during recredentialing?

Whether a provider can continue treating patients depends on their current participation status, the payer's rules, and the applicable contract. Do not assume that a pending review automatically preserves in-network status. Confirm the provider's status and applicable billing rules directly with the payer, and see in-network vs. out-of-network if the answer is no.

Does recredentialing happen automatically?

No. Some payers send notices or initiate an electronic review, but practices remain responsible for responding to requests, providing accurate information, and meeting applicable deadlines. Maintain an internal tracking system even when the payer has its own reminders.

Who is responsible for recredentialing: the provider or the practice?

Responsibility depends on the practice's arrangements and payer requirements. The clinician is generally responsible for providing accurate personal credentials and supporting information, while the practice's credentialing team may coordinate applications, track deadlines, and follow up with payers. Assign explicit ownership so that required actions are not missed.

How far in advance should a practice start recredentialing?

A practical internal approach is to begin preparing about 120 days before the expected deadline, then verify the payer's actual submission window. Starting early gives the practice time to update CAQH, obtain current documents, resolve discrepancies, and follow up on incomplete applications. The same working-back logic applies to initial credentialing for a new hire.

Does Medicare revalidation follow the same three-year cycle?

Not generally. Medicare provider enrollment revalidation is a separate process from commercial health plan recredentialing. CMS generally requires Medicare providers and suppliers to revalidate every five years, while durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers generally revalidate every three years. CMS may also require off-cycle revalidation. Check the official CMS revalidation guidance for your enrollment type and due date.

Final takeaway

Recredentialing keeps a provider's network participation current, but staying compliant requires more than tracking a three-year cycle. Practice managers need to monitor each payer's requirements, respond to recredentialing requests, maintain supporting documents, and verify that reviews are complete.

The most important distinction is between recredentialing and CAQH re-attestation. Under NCQA credentialing standards, recredentialing follows a three-year cycle, while CAQH re-attestation is generally required every 120 days, or 180 days for providers whose primary practice state is Illinois. Both need their own reminders and completion records.

Build a tracker for every provider-payer combination, start the process early, and retain confirmation of completion. That makes it easier to identify approaching deadlines, resolve missing information, and reduce the risk of avoidable disruptions to network participation and claims.

If your team wants credentialing and re-attestation managed as ongoing operational work rather than tracked by hand, Supabill is one option to evaluate.

Sources

1. NCQA. Credentialing. ncqa.org
2. NCQA. Credentialing standards and consumer protection. ncqa.org
3. CAQH. Provider Data Portal user guide. caqh.org
4. CMS. Revalidations, renewing your enrollment. cms.gov

Related reading

• CAQH credentialing: what it is and how to complete it
• CAQH attestation: how to complete and re-attest your profile
• Insurance credentialing for behavioral health practices
• Credentialing vs. contracting vs. enrollment
• How long does provider credentialing take?
• How to credential with Aetna
• How to credential with Cigna, via Evernorth
• How to credential with Optum and UnitedHealthcare
• How to credential with Blue Cross Blue Shield