A provider falls out of network the day a re-cred date slips. Build the calendar backward instead.
Here is the short answer: drive the recredentialing cycle off the verification calendar, not the other way around. NCQA wants providers re-credentialed within 36 months, CMS wants Medicare enrollment revalidated every 5 years, and CAQH attestations expire every 120 days. Credential OS watches all three clocks, fires primary-source verification and attestation reminders on a fixed lead schedule, and closes the file before the deadline instead of after the termination letter.
Four separate deadlines, one missed date, same result
Most groups track one of these and get surprised by the other three. Each authority sets its own cycle and its own definition of an acceptable primary source. Credential OS treats them as one merged calendar per provider.
The 36-month cycle
NCQA CR standards require recredentialing within 36 months of the prior decision, with license, DEA, board certification and sanctions re-verified at the source.
Medicare revalidation
CMS revalidates enrollment every five years under 42 CFR 424.515, and can issue off-cycle requests. A missed PECOS deadline deactivates billing privileges.
Primary-source only
NCQA and Joint Commission MS.06.01.05 require verification from the issuing source, the state board, the ABMS board, the NPDB, not a photocopy in a folder.
Re-attestation
CAQH profiles must be re-attested every 120 days. Payers pull the profile at load time, so a lapsed attestation quietly stalls every downstream enrollment.
The re-cred runway: what fires, and when
Pick the earliest of the four deadlines for each provider. Credential OS anchors on that date and works backward, so verification finishes with room to spare instead of a scramble at T minus zero.
Roster sweep
Engine flags every provider whose earliest clock expires in six months and opens the re-cred file.
Attestation ping
CAQH re-attestation reminder to the provider, aligned to the 120-day expiry so the profile is fresh.
PSV pulls
Automated primary-source checks: state board license, DEA, ABMS certification, NPDB, OIG and SAM exclusions.
Exception clears
Only mismatches and expirables reach a human. Committee packet assembles from verified fields.
Decision logged
Approval recorded, next 36-month clock set automatically. Zero days out of network.
Eight items that decide whether a re-cred holds up
This is the list an auditor walks. Hover any row to check it off. Each item names its primary source, because a folder scan is not verification.
State license, verified at the board
Pull current status and expiry directly from the state licensing board, not a stored PDF. Flag any pending action.
Source: State BoardDEA and state CDS registration
Confirm DEA number, schedules and expiry against the DEA registry for any prescriber on the roster.
Source: DEA / CSABoard certification status
Verify at ABMS or the relevant specialty board, including recertification dates for time-limited certificates.
Source: ABMS BoardNPDB continuous query
Malpractice history and adverse actions checked against the National Practitioner Data Bank at each cycle.
Source: NPDBOIG and SAM exclusion screen
Confirm the provider is clear on the OIG LEIE and SAM.gov exclusion lists before the file re-opens for billing.
Source: OIG LEIE / SAMCAQH profile re-attested
Confirm the ProView attestation is inside its 120-day window so payer pulls read current data.
Source: CAQH ProViewMalpractice coverage current
Verify the certificate of insurance shows active coverage meeting each payer's minimum limits through the next cycle.
Source: Carrier COIPECOS enrollment revalidation
Check the Medicare revalidation due date in PECOS so the five-year clock never deactivates billing privileges mid-cycle.
Source: CMS PECOSWhy the tracker sheet always finds the deadline late
A shared spreadsheet is a record of what already happened. It does not watch a clock or pull a source. That gap is where providers quietly expire.
Manual tracker
Reactive, folder-based- x One person owns the calendar in their head
- x Verification is a stored copy, not a live source pull
- x CAQH lapses discovered when a payer rejects the load
- x Revalidation surfaces after the deactivation letter
- x Audit prep is a week of screenshotting sources
Credential OS
Deadline-driven, source-of-truth- ✓ Merged 36-month, 5-year and 120-day calendar per provider
- ✓ Primary-source pulls timestamped at each cycle
- ✓ Attestation reminders fire on the 120-day window
- ✓ PECOS revalidation flagged 180 days out
- ✓ Committee packet and audit trail assemble themselves
Illustrative operating model, not a client case. Numbered intervals reflect the regulatory cycles named above, not measured client outcomes.
Verification drives the calendar, the calendar drives the reminders
This is the loop. It never stops, and it never waits for someone to remember a date.
Watch the clocks
Engine holds every provider's earliest expiry across all four authorities.
Fire reminders
Attestation and document requests go out on the fixed lead schedule.
Pull the source
Primary-source verification runs and timestamps against each issuing authority.
Reset the clock
Decision logged, next 36-month cycle set, loop restarts. No gap days.
Stop chasing re-cred dates. Let the calendar chase them.
Credential OS is the primary-source verification engine behind ASP-RCM Solutions. It merges your NCQA, CMS, PSV and CAQH clocks into one runway and fires the reminders so no provider falls out of network on a date nobody was watching. Bring us your roster and we will show you which clocks are already close.
Map my re-cred runwayGuidelines referenced: NCQA Credentialing and Recredentialing (CR) standards, 36-month cycle; CMS Medicare enrollment revalidation, 42 CFR 424.515, five-year cycle via PECOS; primary-source verification standards under NCQA CR and Joint Commission MS.06.01.05; CAQH ProView 120-day re-attestation; OIG LEIE and SAM.gov exclusion screening; NPDB continuous query. Cycle intervals are the published regulatory windows, not measured client results.
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