Credentialing · Illinois (IL) · Family Medicine
A plain-language walkthrough of provider credentialing — CAQH sync, primary-source verification (PSV), OIG-LEIE sanctions screening, and payer enrollment — and how ShtegMed tracks each phase.
Provider roster intake, CAQH attestation check, and document collection. Missing or stale CAQH attestations are the most common cause of downstream delay.
State license boards, DEA registration, and board certification are verified at the primary source. ShtegMed is fail-closed: an unreachable or unconfigured source yields INDETERMINATE — a provider is never assumed verified.
OIG-LEIE, SAM.gov, and NPDB screening with ongoing re-screening. Any blocking hit marks the provider SANCTIONED and stops new settlement advances through the gate.
Per-payer enrollment for claims (EDI) and remittance (EFT). NOT_ENROLLED is surfaced as a non-blocking warning so clean claims are not silently held.
License-expiry windows drive EXPIRING_SOON warnings ahead of lapse, supporting the recredentialing work each reappointment cycle requires.
All durations are typical industry estimates, not guarantees. Actual timelines vary by state board, payer, and completeness of the provider file. ShtegMed surfaces live per-phase status instead of promising a fixed turnaround.
Credentialing verifies a provider at the primary source: state medical/professional licenses, DEA registration, board certification, and sanctions screening against OIG-LEIE, SAM.gov, and NPDB — followed by per-payer enrollment. Initial credentialing plus enrollment typically takes 60–120 days end to end (estimated; it varies by board and payer).
No. ShtegMed syncs with the CAQH profile as the shared application data source and layers primary-source verification, sanctions screening, and enrollment tracking on top of it.