How to Get Credentialed with Carelon in Massachusetts
Quick Overview
Timeline
60 - 90 days
CAQH
Required
Re-credentialing
Every 3 year(s)
Delegated
No
Step-by-Step Enrollment Process
Gather Required Documents
Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and any state-specific requirements for Massachusetts.
Complete Your CAQH ProView Profile
Carelon requires a current CAQH ProView profile. Create or update your profile at proview.caqh.org and attest within 120 days.
Submit Your Application
Submit your completed enrollment package to Carelon.
Track & Follow Up
Credentialing typically takes 60-90 days. Monitor your application status and respond promptly to requests for additional information.
Required Documents Checklist
Board Certification
ConditionalRequired if board certified; highly recommended
CV/Resume
5-year work history minimum; gaps > 6 months must be explained
DEA License
ConditionalRequired if prescribing controlled substances
Malpractice Insurance
Medical Degree
Medical License
NPI Certificate
Professional Reference
3 peer references required
Enrollment Forms
CAQH ProView
Universal credentialing application used by most commercial and BCBS payers.
RequiredFree Tools for Your Carelon Enrollment
Related Articles
Credentialing for Behavioral Health and Substance Abuse Providers: Navigating SAMHSA, State Requirements, and Payer Panels
Behavioral health credentialing varies by license type (LCSW, LPC, LMFT, PsyD, PMHNP). Navigate SAMHSA requirements, clo...
Can You Bill Retroactively After Credentialing? Medicare, Medicaid, and Commercial Payer Rules Explained
Can you bill retroactively after credentialing? Medicare allows 30 days, Medicaid varies by state, most commercial payer...
How Long Does Credentialing Really Take? Timelines by Payer, Specialty, and State
Medicare: 45-65 days. Aetna: 45-90 days. BCBS: 30-90 days. Full breakdown of credentialing timelines for 10+ major payer...
Key Credentialing Terms
- CAQH
- The Council for Affordable Quality Health Care, an organization that maintains a universal provider database (CAQH ProVi...
- Credentialing
- The process of verifying a healthcare provider's qualifications, training, licensure, and professional background to ens...
- Effective Date
- The date on which a provider's enrollment or network participation becomes active, allowing them to begin billing a paye...
- NPI
- The National Provider Identifier is a unique 10-digit identification number issued by CMS to healthcare providers, requi...
- Primary Source Verification
- The process of verifying a provider's credentials directly from the original issuing source, such as medical schools, li...
- Provider Enrollment
- The process by which a healthcare provider applies to participate in an insurance payer's network, allowing the provider...
- Re-credentialing
- The periodic process, typically occurring every three years, in which a provider's credentials are re-verified to ensure...
Credentialing Checklist
Make sure you have everything ready before applying to Carelon.
View Physician Credentialing Checklist →Contact Information
Provider Credentialing
National1-800-397-1630
Mon-Fri 8am-5pm ET
Provider Relations
National1-800-397-1630
Behavioral Health Provider Line
National1-800-397-1630