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How to Get a New Practice Credentialed in Georgia
Work in dependency order. A new practice usually needs its legal and tax identity, organizational and individual NPIs as they apply, current provider records, a ready CAQH profile, and then payer-specific applications. The exact sequence varies by provider type, ownership, service location, and payer. Georgia Medicaid and CMO steps must be confirmed from current state sources, and submitting applications does not mean a practice is credentialed.
Last reviewed 2026-11-05 by Valerie. Next review 2027-02-05.
The sequence
- Set up the entityLegal, tax, address, ownership.
- Prepare provider filesLicenses, NPIs, taxonomy, CAQH.
- Choose payer prioritiesBased on patients and referrals.
- Submit applicationsThrough each payer's current path.
- Track milestonesSubmitted to activated.
- Check setupDirectory and billing after the effective date.
1. Before any payer application
- Legal entity and EIN.
- Banking and remittance decisions.
- Practice and service-location addresses.
- Ownership information.
- Licenses.
- Organizational and individual NPIs and taxonomy codes.
2. Prepare the provider file and CAQH profile
Collect current provider records and get the CAQH profile complete and attested, with supporting documents uploaded and the intended payers authorized to view it.
3. Choose payer priorities
Prioritize payers by where your patients and referrals come from. A payer's network may be closed or limited, and that is the payer's decision. Do not assume any network is open.
4. Submit through the correct current paths
Medicare, Georgia Medicaid, and each commercial payer have their own applications and requirements, and they change. Confirm each from its current official source rather than from memory, and do not assume all payers need the same application or order.
5. Track milestones as separate events
| Milestone | What it tells you |
|---|---|
| Submitted | You sent the application and have proof. |
| Acknowledged | The payer confirmed it received it. |
| Correction requested | The payer needs something more from you. |
| Approved | The payer decided to approve. |
| Effective | The date participation begins. |
| Activated | The payer's systems show you in network. |
6. Validate directory and billing setup
After the effective date, confirm the practice and providers appear correctly in each payer's directory and that billing setup matches the approval.
Common questions
No. Submitted is one milestone. The practice is credentialed with a payer only when that payer approves it, and billing depends on the effective date.
No. Each payer has its own path, and Medicare, Georgia Medicaid, and commercial payers differ.
No. Marlien does not negotiate payer contracts, reimbursement rates, fee schedules, or participation terms.
Next step
You are not charged when you build a plan. Payers and state agencies control review, participation, approval, effective dates, and timing. Marlien does not negotiate payer contracts, reimbursement rates, fee schedules, or participation terms.
Keep reading
- Georgia Medicaid timeline
- Medicare enrollment through PECOS
- CAQH re-attestation guide
- Georgia enrollment
Official sources
- Georgia Medicaid provider enrollment (Georgia MMIS portal)
- CMS: become a Medicare provider or supplier
- CAQH ProView practitioner quick reference guide
Instructions and timing change. Confirm the current instructions with the source before relying on this page. This guide is educational, is not legal advice, and does not replace payer instructions.