Credentialing by payer
Join the Medicare Advantage plans Network
- Flat PricesNo percentage of collections
- Half Now, Half at SubmissionFor every enrollment application
- Closed Network?Your choice of a refund or a credit
- Live Status TrackingCheck any application by reference number
Medicare Advantage plans at a Glance
| Service area | Nationwide: just over 35 million people were in Medicare Advantage as of February 2026, 54% of eligible beneficiaries in 2025 (KFF). |
|---|---|
| How to request to join | Each plan's own process, usually the same front door as its commercial line: Aetna's Medical application, UnitedHealthcare's Onboard Pro, Humana's self-nomination form. |
| CAQH ProView (DataSpring) | Most MA carriers credential from CAQH (DataSpring). Federal rules require a signed written application with primary source verification of licensure. |
| Recredentialing | At least every three years, required by 42 CFR 422.204(b)(2)(ii). |
| Lines of business | Part C plans, including HMO, PPO and special needs plans; KFF attributes most recent enrollment growth to special needs plans. |
How Medicare Advantage plans Takes Applications
Medicare Advantage is a commercial contract layered on Medicare enrollment, so an active PECOS enrollment comes first, then each plan's credentialing and contract. The federal rule in 42 CFR 422.204 sets the floor every plan follows: written application, primary source verification, and recredentialing that also reviews quality and grievance data.
What to Watch With Medicare Advantage plans
The rule also bars plans from contracting with excluded individuals and ties them to the Medicare opt-out rules; Highmark, for one, states that practitioners who opted out of Medicare are not eligible to see its MA members. Ownership shifts matter too: Cigna's Medicare Advantage business moved to HCSC in March 2025, and UnitedHealth Group, the largest MA insurer, lost over 530,000 enrollees between February 2025 and February 2026 while Humana added about 1.2 million.
Whatever the plan, the file moves only when your CAQH (DataSpring) profile, license record and application agree. See how long credentialing takes and our CAQH profile setup service.
Questions About Medicare Advantage plans
How do I apply to Medicare Advantage plans?
Each plan's own process, usually the same front door as its commercial line: Aetna's Medical application, UnitedHealthcare's Onboard Pro, Humana's self-nomination form.
How long does Medicare Advantage plans credentialing take?
Medicare Advantage plans does not publish a turnaround on the provider pages we checked; most commercial plans land between 90 and 120 days from a complete file. Recredentialing: At least every three years, required by 42 CFR 422.204(b)(2)(ii).
Does Medicare Advantage plans use CAQH (DataSpring)?
Most MA carriers credential from CAQH (DataSpring). Federal rules require a signed written application with primary source verification of licensure.
What does PECS charge for each plan?
$200 per application per provider, half at engagement and half at submission, including follow-up with each plan until the effective date is set.
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Sources
- 42 CFR 422.204: Provider selection and credentialing
- KFF: Medicare Advantage enrollment, 2026
- HCSC: Completes acquisition of Cigna Medicare businesses
Facts checked against the sources above in October 2026; plan procedures change.