Hiring a new physician should feel like progress, not a revenue setback. Yet without proper credentialing, claims can be denied or delayed for months, leaving practices caught between growing patient demand and unpaid services.
Credentialing delays are one of the biggest bottlenecks in the U.S. healthcare system. Knowing what to expect, and what to avoid can help providers keep revenue moving while staying compliant.
When Should You Start the Credentialing Process?
Start at least 3–4 months before a provider’s start date. If you’re onboarding multiple providers, plan for 6 months or more. Waiting too long can result in 90–120+ days of unpaid claims.
What If Your CAQH Profile Is Outdated?
An incomplete or outdated CAQH profile can stall applications for weeks. Keep everything updated:
- Licenses
- DEA registration
- Malpractice insurance
- Board certifications
Complete attestations every 120 days to avoid unnecessary delays.
How Do State and Facility Requirements Affect Credentialing?
Every state and facility has unique requirements. Missing one step can extend timelines significantly. Examples include:
- State Medicaid programs with extra forms
- Hospitals and surgical centers requiring separate privileging
Maintain a checklist for each state and facility to stay on track.
How Can a Digital Credentialing Packet Help?
Missing documents are one of the top causes of delays. A digital packet should include:
- NPI confirmation
- DEA certificate
- Current CV
- Board certifications
- State licenses
- Malpractice insurance
Using a shared, cloud-based system allows providers and staff to upload updates in real time.
What’s the Best Way to Track Applications?
Credentialing isn’t “submit and done.” Stay on top of applications by:
- Logging submission dates and payer contact info
- Following up every 10–14 days
- Assigning a dedicated owner for each application
This prevents lost applications and reduces lag time.
What Red Flags Can Cause Delays?
Common reasons for denials or stalled applications include:
- Name mismatches between licenses and NPIs
- Expired documentation
- Gaps in work history
Always do an internal review before submitting to avoid rework.
How Do You Stay Ahead of Payer Changes?
Payers frequently change credentialing requirements, often without direct notice. To avoid setbacks:
- Monitor payer portals weekly
- Document updates immediately
- Work with a credentialing partner who tracks these changes daily
When Should You Outsource Credentialing?
Credentialing requires persistence and precision. Outsourcing makes sense if:
- Your team is already stretched thin
- You’re scaling quickly with multiple providers
- You want to reduce delays and denials
Professional credentialing support helps practices focus on patients while keeping revenue flowing.
