Provider credentialing is an essential, yet often time-consuming, process that directly impacts a practice’s ability to generate revenue. Without proper credentialing, providers can’t bill insurance companies or receive reimbursement for their services. Delays or mistakes in this process can lead to months of lost revenue and administrative headaches.
Here’s how to streamline credentialing processes and avoid unnecessary delays:
Why Credentialing Matters
Credentialing verifies that a provider meets the qualifications required by insurance companies and state and federal regulations. It includes checking licensure, education, training, certifications, malpractice history, and more. Providers must be fully credentialed and enrolled with each payer before billing for services.
Missed deadlines, missing documents, or outdated information can stall the process and lead to payment denials—even when services were legitimately provided.
Steps to Streamline Credentialing
1. Start Early
Credentialing can take 90 to 120 days—or longer. Begin the process as soon as a new provider is hired or when updating information for an existing one.
2. Keep Documents Updated
Missing or expired information is one of the top causes of delays. Maintain a digital credentialing file for each provider with up-to-date licenses, DEA certificates, board certifications, and CVs.
3. Use a Tracking System
Whether it’s a credentialing software platform or a well-organized spreadsheet, use a system to track applications, deadlines, and recredentialing dates. Set reminders to follow up with payers.
4. Communicate with Payers
Don’t assume the payer is processing your application promptly. Check in regularly, ask for updates, and clarify next steps to prevent your application from sitting in limbo.
5. Understand Payer Requirements
Each payer has different forms, timelines, and rules. Keep payer-specific checklists to ensure every application is submitted correctly the first time.
Credentialing is Too Important to Get Wrong
At MedCycle Solutions, we take the stress out of credentialing by managing the process from start to finish. Our team stays up-to-date with each payer’s requirements, follows up consistently, and keeps your credentialing on track—so you can focus on seeing patients and getting paid.
If you’re struggling with credentialing delays or lost revenue, we’re here to help.