Credentialing is a critical administrative task that enables healthcare providers to be reimbursed by insurance companies. When there are credentialing delays or the process is mismanaged, the effects can be financially damaging to your organization—yet it’s an area often overlooked.
Credentialing Affects Revenue Directly
A provider who isn’t credentialed can’t bill for their services. Even if they’re actively seeing patients, you can’t collect payment until the paperwork is approved by payers. A 60- to 90-day delay in credentialing can result in tens of thousands of dollars in lost revenue, particularly for high-volume specialties.
Common Causes of Delay
- Incomplete applications: Missing details or signatures delay processing.
- Discrepancies in records: Mismatched license or malpractice dates can trigger rejections.
- Lack of follow-up: If no one’s tracking application status, errors often go unnoticed.
- Miscommunication: Coordination between HR, credentialing departments, and payers is key.
Real-World Consequences
Delays impact more than just billing. New providers may be left idle or need to work unpaid while waiting. Patient care access may suffer, and the administrative burden of retroactive billing (if even allowed) creates stress and complexity.
Best Practices to Prevent Delays
- Start early: Begin the process at least 90–120 days before a provider’s start date.
- Assign responsibility: Ensure someone owns the credentialing process and communicates regularly with all stakeholders.
- Leverage expertise: Partner with credentialing professionals who understand payer-specific requirements.
- Use tracking tools: Implement systems to monitor deadlines and progress across all applications.
Conclusion
Credentialing delays aren’t just a paperwork problem—they’re a serious threat to cash flow. By taking a strategic, proactive approach, you can avoid interruptions in service and ensure providers are billing-ready from day one.