Provider Credentialing Requirements: Documents That Cause Delays

Avoiding Credentialing Delays Starts with the Right Documents

Enrolling with insurance payors should be straightforward, but small mistakes in your paperwork can cause massive delays. One of the biggest reasons credentialing stalls? Documents that don’t match exactly across the board—even something as small as a space, comma, or abbreviation can trigger a rejection.

At pie, we handle the credentialing process for you, ensuring everything is in order before submission. However, some steps require your direct action, especially when dealing with the IRS, your bank, and state agencies. The best way to avoid delays is to be prepared in advance and know what documents payors require.

Here’s a breakdown of the documents that most often cause delays and what you need to do to keep the process moving.

Your CP-575 Letter: Why It’s Critical

When your business first registered for an Employer Identification Number (EIN), the IRS sent a CP-575 letter confirming it. This document is essential because payors use it to verify your business’s legal name and tax ID.

Why it matters:
If the name or EIN on your CP-575 doesn’t match exactly with your other documents, insurance companies may reject your credentialing application. Even minor differences—like a missing comma or an extra space—can cause issues.

What you need to do:

• If you don’t have a copy, you must request a 147C Letter from the IRS by calling 1-800-829-4933.
• This process takes 4–6 weeks, so if you need this letter, request it as soon as possible.

At pie, we ensure all your submitted documentation is consistent—but we can’t request IRS documents on your behalf. If you’re missing your CP-575, we’ll guide you on how to obtain it.

W-9 Form: Do Your EIN and Business Name Match?

The W-9 form verifies your Taxpayer Identification Number (TIN) and is required before payors will process claims.

Why it matters:
Payors compare your W-9 to your CP-575. If the business name or EIN does not match exactly, your application may be rejected.

What you need to do:

• Ensure your W-9 reflects the exact business name and EIN from your CP-575.
• If your business entity has changed, submit an updated W-9.

At pie, we make sure your credentialing paperwork is accurate, but you’ll need to provide the correct W-9 to ensure a smooth process.

NPI Confirmation: Is Your Business Name Up to Date?

Your National Provider Identifier (NPI) is another key credentialing requirement. Payors verify that your NPI details match your tax records before processing enrollment.

Why it matters:
If your NPI registration has an outdated business name or address, it can cause delays.

What you need to do:

• Log in to NPPES and confirm that your NPI details match your CP-575 and W-9 exactly.
• If anything is incorrect, update your NPI before submitting your credentialing paperwork.

At pie, we handle credentialing applications, but your NPI profile must be accurate before we can proceed.

Bank Account Letters and Voided Checks: Why Payors Require Them

Some payors require a bank account verification letter, while others ask for a voided check. These documents confirm your business banking details so insurance companies can send payments to the correct account.

Why it matters:
If the name on your bank account does not match your CP-575 and W-9, payors may reject payments, causing delays in reimbursement.

What you need to do:

• Request a bank account verification letter from your bank, ensuring your business name appears exactly as it does on your CP-575.
• Provide a voided check if required.

While pie submits financial documents for credentialing, you must obtain these directly from your bank.

Business Licenses: Do You Need One?

Not all providers need a business license, but in certain states, payors may require it before approving enrollment.

Why it matters:
If a business license is required in your state and you don’t provide it, your credentialing application may be put on hold.

What you need to do:

• Check with your state’s business licensing department to confirm if this applies to you.
• If required, provide a copy to ensure a smooth credentialing process.

At pie, we’ll let you know if this is needed for your application.

The Matching Rule: Treat It Like a Password

One of the most common reasons credentialing is delayed? Documents that don’t match exactly across the board.

Payors expect every document—CP-575, W-9, NPI, contracts, bank letters, and more—to match perfectly. If one document says "ABC Healthcare, LLC" and another says "ABC Healthcare LLC" (without the comma), it can cause major issues.

Think of it like a password—one small typo, and the system won’t let you through.

Get Credentialed Faster with pie

At pie, we take care of the credentialing process for you, ensuring all submitted paperwork is accurate, complete, and formatted correctly.

However, certain documents—like those from the IRS, your bank, and state agencies—must be obtained directly by you. The sooner these are ready, the faster your credentialing can be completed.

Want to get credentialed without delays? Visit pie to get started today.