Credentialing
Recredentialing and Credentialing Maintenance
Recredentialing never ends: federal rules require Medicare Advantage plans to recredential network clinicians at least every 3 years, and CAQH, Medicare and Florida Medicaid each run their own clock, from every 120 days to every 5 years. Miss a date and that payer can hold, suspend or end your payments. We keep each provider's CAQH, plan, Medicare and Florida Medicaid dates on one calendar and do those filings.
The short answer
How often is recredentialing required?
It depends on the payer: reattest your CAQH profile every 120 days, expect each health plan to recredential you at least every 36 months, revalidate Medicare every 5 years (3 for DMEPOS suppliers) and renew Florida Medicaid every 3 or 5 years. The Advixor Group reattests CAQH profiles, answers each plan's recredentialing request, revalidates Medicare in PECOS and renews Florida Medicaid for every base ID.
SourcesDataSpring user guide v46.042 CFR 422.20442 CFR 424.515AHCA Provider Enrollment Policy
Your calendar
Your recredentialing and renewal calendar
A provider in five networks has five recredentialing dates.
| Item | Cycle | Notice you get | If it’s missed |
|---|---|---|---|
| CAQH reattestation | 120 days (180 in Illinois) | Emails 15, 10 and 5 days before | Expires the next day; plans pause or terminate |
| Plan recredentialing | At least every 36 months | Set by each plan | Termination or administrative decredentialing |
| Medicare revalidation | 5 years (DMEPOS suppliers: 3) | Due date posted 7 months ahead; MAC notice 3–4 months ahead | Payment hold or deactivation |
| Florida Medicaid renewal | 5 years (non-institutional providers); 3 years (institutional, DME, crossover-only, ordering/referring, out-of-state) | About 90 days ahead | Claims suspend; no fee-for-service or plan payment |
| Florida license | 2 years (autonomous APRNs: 10 extra CE hours) | Board renewal | You can’t practice; plans re-verify |
| DEA registration | 36 months ($888 fee) | DEA renewal | No controlled-substance prescribing; the CAQH copy expires |
| Clearinghouse fingerprints | 5 years; renewal opens 60 days before ($43.25) | AHCA tells the employer at 60, 30 and 21 days, for employees on your AHCA roster | Prints purged; full new screening |
Sources DataSpring user guide v46.0; 42 CFR 422.204, 424.515; CMS, Revalidations; AHCA Medicaid enrollment policy §6 (Feb 2026); ss. 458.319, 464.013, 464.0123, F.S.; 21 CFR 1301.13; AHCA Clearinghouse (Oct 2026).
Between cycles, each change you report has its own deadline:
Sources 45 CFR 162.410(a)(4); 42 CFR 424.516(d); AHCA, Florida Medicaid Provider Enrollment Policy §5 (Feb 2026). Read Oct 2026.
Health plans
The recredentialing process and CAQH reattestation
Under the Medicare Advantage rule, each review updates what the plan verified the first time and weighs quality data, grievances and appeals, and member satisfaction surveys (42 CFR 422.204(b)(2)). Each plan runs it differently.
3years
Each plan’s published cycle (Humana’s policy: 36 months), read October 17, 2026:
- Aetna
- Florida Blue
- UnitedHealthcare
- Humana
- UnitedHealthcare starts automatically near the 3-year mark and sends nothing if your CAQH profile is current. If it isn’t, a notice comes from UnitedHealthcare or its verification vendor, then reminders.
- Humana re-verifies your license, DEA or CDS certificate and board certification, and checks sanctions and the Medicare opt-out list. It may still recredential within 30 days of a missed 36-month deadline; after that, the practitioner starts over with initial credentialing.
- Florida Blue needs an updated application and documents, and not sending them can end your contract.
- Cigna asks you to update and re-sign your CAQH profile, sends up to three reminder emails, and terminates participation if you don’t.
All four work from your CAQH profile: Humana requires it and Florida Blue prefers it. Since June 7, 2026 it has been DataSpring, powered by CAQH, with the same portal, login and profile. More than 1.9 million clinician profiles sit on its 120-day reattestation cycle, and DataSpring also offers an optional directory confirmation every 90 days.
Medicare
Medicare revalidation: the lookup tool and the 60-day clock
CMS’s Medicare revalidation tool is the Medicare Revalidation List: search it by individual or organization to find each due date. Once the request arrives, you have 60 calendar days to send a complete application with its supporting documents (42 CFR 424.515(a)(2)), and CMS grants no extensions. A practitioner who doesn’t respond also loses every reassignment to a group. Institutional providers also pay an application fee at revalidation; CMS expects 33,863 of them to pay it in 2026.
Deactivation
When a missed revalidation deactivates Medicare billing
Your MAC can deactivate billing privileges on its own for:
- no complete response to a revalidation request or a revalidation information request within 90 days;
- no active reassignment or practice location for 90 days or more;
- an EFT agreement closed with no replacement within 90 days;
- an expired license and no billing.
Six consecutive months without a claim is a ground too (it used to be 12), but the MAC applies it only at CMS’s direction (Program Integrity Manual §10.4.8).
Reactivation takes effect on the date the MAC receives the submission it approves, and a Part B supplier comes back with a new PTAN. A stay of enrollment pauses you for up to 60 days, and claims for that stretch are rejected unless you’re compliant again before it ends. A revocation bars re-enrollment for 1 to 10 years, up to 20 after a second one; no bar applies when the only reason was an unanswered revalidation or information request. CMS’s CY 2027 Home Health final rule (Nov 4, 2026) makes every revocation ground retroactive.
“If your Medicare billing privileges are deactivated, you’ll need to re-submit a complete Medicare enrollment application to reactivate your billing privileges. Medicare won’t reimburse you for any services during the period that you were deactivated.”
Florida Medicaid
Florida Medicaid revalidation: renewal every 3 or 5 years
Florida Medicaid calls its revalidation a renewal, filed in the secure Florida Medicaid Web Portal, where the renewal link opens 90 days before the agreement expires.
- 1notice for each base ID: AHCA sends them separately, so a practice with three base IDs gets three notices.
- 30days of written notice lets either side end the provider agreement without cause. A lapsed license, certification, accreditation, insurance policy or bond is different: the termination can take effect in less than 30 days, dated back to the lapse (Provider Enrollment Policy §8.2.1).
Source AHCA, Florida Medicaid Provider Enrollment Policy (Feb 2026).
Our service
How our credentialing maintenance service keeps you on schedule
We file ahead of each due date and track license, DEA, malpractice and fingerprint expirations as well as payer dates. Maintenance is priced to your providers and plans: we go over your needs first and quote it in writing. The credentialing package (one tax ID, up to five providers) is described on credentialing cost, and first-time credentialing on credentialing services.
Credentialing maintenance
For each provider and tax ID, we:
- Reattest and maintain CAQH profiles
- Answer each plan’s recredentialing request with the updated application and documents it asks for
- Revalidate Medicare in PECOS and renew Florida Medicaid for every base ID
- Send every payer its roster updates, provider additions and terminations, and changes of location, tax ID, name and phone
What’s included
What our recredentialing service includes
CAQH and NPI
Your DataSpring (CAQH) profile and NPI record, set up correctly and kept accurate.
Learn moreMedicare enrollment
Medicare enrollment in PECOS: the CMS-855I, reassignments and your effective date.
Learn moreFlorida Medicaid enrollment
Florida Medicaid enrollment for practitioners and groups: the provider agreement and base IDs.
Learn morePayer enrollment
Joining a new plan, or adding a provider or location to the contracts you already hold.
Learn moreFlorida Medicaid plans
Credentialing with the Florida Medicaid health plans that serve your region.
Learn morePTAN number
Find and check the PTAN on your Medicare approval letter.
Learn moreQuick answers
Recredentialing questions: revalidation, PECOS, deactivation and leave
Recredentialing versus revalidation, Medicare's cycle, PECOS, deactivation disputes and providers on leave. Ask about your own due dates in a consultation.
Is recredentialing the same as revalidation?
How often is Medicare revalidation required?
How do I revalidate my Medicare enrollment in PECOS?
How do I dispute a deactivation after a missed revalidation?
A provider was on leave when recredentialing came due. What happens?
Talk to an advisor
You care for patients. Who’s taking care of the business?
Tell us where your practice is today. We will tell you what we would do first.
Official sources
- eCFR, read Oct 17 and 19, 2026: 42 CFR 422.204 (Medicare Advantage credentialing); 424.515, 424.516, 424.540 and 424.541 (Medicare enrollment); 45 CFR 162.410 (NPI); 21 CFR 1301.13 (DEA)
- CMS: Revalidations (07/29/2025) and the Medicare Revalidation List; Program Integrity Manual, ch. 10 (Oct 13, 2026); CY 2026 application fee notice, 90 FR 55738; CY 2027 Home Health final rule, 91 FR 72022 (Nov 9, 2026), §V.C. Read Oct 17 and 19 and Nov 11, 2026
- DataSpring: Provider User Guide v46.0 (June 15, 2026) and For Clinicians. Read Oct 17, 2026
- Health plans: Humana, Credentialing and Recredentialing Policy; UnitedHealthcare, Credentialing and recredentialing FAQ (Oct 14, 2026); Florida Blue, Provider Manual (Sep 24, 2026); Cigna, Credentialing; Aetna, provider manual (June 2026). Read Oct 17, 2026
- Florida: AHCA, Florida Medicaid Provider Enrollment Policy (Feb 2026); AHCA, Clearinghouse Renewals (Oct 13, 2026); Florida Statutes ss. 458.319, 464.013 and 464.0123 (2026); DEA fee rule, 85 FR 44710. Read Oct 17, 2026