Provider Network Build Checklist

Document the exact county list and LOB combination for each submission.

Each LOB has different governing regulations and standards.

If CMS issued a gap notice last year, review findings before building this year's network.

RUCA codes determine which time/distance standard applies.

Document shortage evidence early — access exceptions require supporting documentation.

Federally Qualified Health Centers and Rural Health Clinics often satisfy PCP adequacy requirements.

Incomplete or outdated CAQH profiles are the #1 credentialing delay.

CMS requires detailed documentation including shortage evidence and alternative access arrangements.

CAP must include explanation of the shortfall and your plan to close it.