Insurance Credentialing Checklist for ABA & Pediatric Therapy Practices

Insurance credentialing is one of the most critical, but often confusing, aspects of running an ABA or pediatric therapy practice. From getting new providers approved to maintaining contracts with Medicaid and other insurers, missing a step can lead to claim delays, denied reimbursements, and administrative headaches.

Year-end is the perfect time to review your insurance credentialing and re-credentialing requirements, ensuring your practice is ready for a smooth start to the new year. Use this checklist to stay organized, reduce delays, and focus on delivering quality care.

Gather All Provider Documentation

• Current license(s) and certifications

• NPI numbers

• Resume or CV

• Malpractice insurance documentation

Tip: Keep digital copies in a secure folder for easy access.

Verify Insurance Payer Requirements

• Check each insurance company's credentialing criteria (they can differ widely)

• Confirm accepted CPT codes and service types

• Note deadlines for submission

• Review re-credentialing requirements for existing contracts: especially medicaid, which often has specific timelines and documentation requirements

Tip: Create a spreadsheet to track requirements per payer to save headaches later.

Complete Applications Accurately

• Fill out all fields completely because missing information delays approval

• Use the exact legal name as listed with state boards and the IRS

• Double-check taxonomy codes

Tip: Assign one person as the "application owner" to maintain consistency.

Prepare Supporting Documents

• Liability and malpractice insurance certificates

• Board certifications

• Continuing education records (if requested)

• W-9 form for tax purposes

Tip: Keep a folder for each provider to streamline renewals and updates.

Track Submission & Follow-Up

• Note submission dates for each payer

• Set reminders for follow-ups (credentialing can take 60-180 days)

• Track status updates in a centralized system

Tip: Consider using credentialing software or a simple shared spreadsheet to prevent things from slipping through the cracks.

Re-Credentialing & Year-End Prep

• Review re-credentialing requirements for all of your insurance contracts, particularly Medicaid

• Year-end is an ideal time to check what's coming due next year

• Keep an annual checklist for license renewals, insurance updates and continuing education

• Monitor for any changes in payer requirements

Tip: Automate reminders in your calendar to stay ahead of deadlines.

Proper credentialing, and timely recredentialing, is essential for keeping your ABA or pediatric therapy practice running smoothly and getting paid on time. Use this insurance credentialing checklist to stay organized, reduce delays, and start the new year ready to focus on what matters most: delivering high-quality care.

Need help managing credentialing, re-credentialing and insurance contracts for your therapy practice? Contact Ārohana Support today to streamline your administrative workflow and maximize reimbursements.