How to Get Credentialed with Carelon in South Carolina
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 South Carolina.
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
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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