New National Shared Credentialing Process for Health Plans to Begin November 1

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A new shared credentialing platform could help providers complete Medicare Advantage and Medicaid managed care credentialing in days instead of months, reducing administrative burden and speeding participation in health plan networks.

Provider credentialing and recredentialing can be one of the more time-consuming aspects of contracting with Medicare Advantage (MA) and Medicaid managed care plans. Many LeadingAge members must submit the same information through separate credentialing processes for each plan they work with, often waiting months before contracts become active and negotiated rates take effect.

A new national credentialing service, CertifyOS, may help streamline that process.

Beginning November 1, 2026, providers participating in certain managed care plans will be able to submit credentialing information through a single online portal that can then be used by all participating health plans. According to the company, UnitedHealthcare, Cigna, and Centene who are founding partners of the initiative will be using the new credentialing service and additional plans are able to join, including some Blue Cross Blue Shield organizations. CertifyOS indicates that its platform is available to providers of all types, which could include post-acute and aging services providers such as nursing homes, home health agencies, hospice providers, and other aging services organizations.

CertifyOS verifies provider information through primary source verification, state licensure checks, NCQA standards, sanctions monitoring, and other validation processes. Participating health plans can then access and use the verified information, eliminating the need for providers to submit the same credentialing submissions across multiple plans and managed care organizations.

One of the most significant potential benefits is speed. The company reports that credentialing timelines could be reduced from a process that often takes months to as little as eight to 10 days. After initial credentialing, CertifyOS also conducts ongoing monitoring and revalidation activities, such as sanctions checks and license verification, and shares updates with participating plans.

CertifyOS states that the service is paid for by participating managed care plans, meaning providers should not incur additional costs to use the credentialing platform.

Because health plan participation is voluntary in this new credentialing portal, not all MA and Medicaid managed care plans will use the platform initially. LeadingAge encourages members to contact their Medicare Advantage and Medicaid managed care plan representatives to learn whether their plans are participating and how the new process may affect contracting, credentialing, and recredentialing timelines.

If widely adopted, this approach could reduce administrative burden for providers, speed network participation, and help organizations bring contracted services online more quickly.

LeadingAge has been advocating for the Centers for Medicare and Medicaid Services (CMS) to develop a similar approach but it appears the private sector may have won the race or at least paved the way for eliminating some of this duplicate effort by providers and plans resulting from credentialing.

Learn more here.