Credentialing Status: Submitted, Approved, Effective, EFT, And ERA Are Not The Same

Credentialing Status Guide

“Submitted” is evidence that an application left your hands. It is not proof that the payer received it, approved it, assigned an effective date, loaded the provider correctly, activated payment enrollment, or can adjudicate a claim.

The Statuses To Track Separately

Prepared

The application, roster, portal record, or enrollment packet is ready, but it has not been transmitted. Record the version, signer, required attachments, and the payer product or program it is meant to reach.

Submitted

The application or roster was sent through the correct portal, email, roster, credentialing vendor, PECOS, or other payer-specific enrollment channel. Keep the submission date, confirmation number, transmitted file, payer destination, and submitter.

Received

The payer or enrollment contractor confirms that it received and logged the work. A portal upload screen or sent email is not always the same as a payer receipt. Keep the payer’s case, ticket, application, or reference number.

In Review

The payer has begun processing the application. Track the last verified date, the current department or reviewer when available, and the next follow-up date.

Additional Information Requested

The payer needs a correction, document, signature, disclosure, clarification, or new form. Record the request, the response deadline, who owns it, what was returned, and confirmation that the response was attached to the original case.

Approved

The payer has approved the enrollment, credentialing, affiliation, or contract step. Keep the approval letter or portal evidence. For Medicare, CMS states that the Medicare Administrative Contractor changes the PECOS record to approved and sends an approval letter.

Effective

The effective date is the date tied to billing participation for the approved relationship. It may differ from the approval date. Keep the effective date in writing and confirm the billing entity, Tax ID, NPI, location, product, and rendering-provider relationship it applies to.

Contracted, Rostered, Or Affiliated

Approval can still require contract execution, group linkage, roster loading, system loading, or product-specific affiliation. Confirm the correct practice agreement and the rendering provider’s relationship to it. Do not treat a provider’s participation through another employer as proof that a new practice can bill.

EFT Active

Electronic funds transfer directs payer payments to the practice’s bank account. CMS Form 588 states that EFT enrollment is for payment authorization and does not itself enroll the provider or supplier in Medicare. Track EFT separately from payer approval and effective date.

ERA Active

Electronic remittance advice delivers the claim-level payment and adjustment detail used for posting and reconciliation. CMS identifies the X12 835 as the national HIPAA ERA standard. EFT can be active while ERA routing is missing or sent to the wrong receiver, so verify both.

Directory Verified

Confirm that the payer directory shows the correct provider, specialty, practice name, address, phone, and accepting-patients status when applicable. Directory accuracy is a separate operational check after approval and loading.

First Claim Accepted And Paid

The final operational proof is a correctly routed claim that is accepted, adjudicated under the intended contract, and reconciled to ERA and payment. A first-claim test can uncover a missing affiliation, wrong billing record, incorrect effective date, or loading error that approval paperwork alone did not reveal.

What A Complete Payer Handoff Should Include

• Exact payer, product, network, program, and service area.
• Billing entity, Tax ID, Type 2 NPI, rendering provider, and location.
• Submission evidence and payer reference number.
• Last verified status, follow-up history, owner, and next action.
• Approval evidence and written effective date.
• Executed agreement or documented affiliation when applicable.
• EFT destination and activation evidence.
• ERA receiver and activation evidence.
• Directory verification.
• First accepted and paid claim evidence, when available.

Official Sources

• CMS: Medicare Provider Enrollment
• CMS: PECOS Enrollment Applications
• CMS-588: Electronic Funds Transfer Authorization Agreement
• CMS: Health Care Payment and Remittance Advice