Getting credentialed with insurance companies can feel like trying to solve a puzzle where someone keeps hiding the pieces. For behavioral health providers, this challenge becomes even more difficult when you’re trying to credential multiple practitioners across different specialties and license types. This is the story of how a large behavioral health group in the Northeast transformed their credentialing chaos into a streamlined operation that allowed them to focus on patient care instead of paperwork.
The Provider Group
A multi-specialty behavioral health organization operating across Pennsylvania and New Jersey had grown from a small practice of three therapists into a group of 47 providers over the course of six years. Their team included psychiatrists, psychologists, licensed clinical social workers, licensed professional counselors, marriage and family therapists, and psychiatric nurse practitioners. They maintained seven physical locations and offered extensive telehealth services.
The group’s rapid growth had been driven by genuine demand for mental health services in their communities. They’d built an excellent reputation for quality care and had wait lists at most of their locations. But behind the scenes, their credentialing and contracting processes had become a nightmare that threatened their ability to serve patients effectively.
The Challenge: Credentialing Bottlenecks Blocking Growth
When this behavioral health group first contacted Medwave, they were drowning in administrative problems that stemmed from their credentialing situation. Their in-house office manager had been trying to handle all credentialing applications, but the workload had become impossible to manage.
At any given time, they had between 12 and 18 providers waiting for credentialing to be completed with at least one major insurance carrier. Some of their newly hired therapists had been sitting idle for four to six months, unable to see patients covered by certain insurance plans because their applications were stuck in processing. The group was paying full salaries to clinicians who could only work at partial capacity.
The problems went deeper than just slow processing times.
Several issues created constant headaches for the practice:
Application Errors and Rejections
- Missing documentation that required resubmission and restarted the entire timeline
- Incorrect information on applications that led to denials
- Outdated provider information that needed correction
- Incomplete attestation forms that sat unnoticed for weeks
Poor Tracking Systems
- No centralized database showing each provider’s status with each payer
- Lost emails from insurance companies requesting additional information
- Missed deadlines for resubmitting corrected applications
- No system for tracking recredentialing dates, leading to last-minute panic
State-Specific Requirements
- Different license verification processes for Pennsylvania versus New Jersey
- Varying insurance requirements between states
- Confusion about which providers could practice in which locations under different payer contracts
Multiple License Types Creating Confusion
- Different credentialing requirements for psychiatrists versus psychologists versus LCSWs
- Some payers required additional documentation for nurse practitioners
- Marriage and family therapists faced longer approval times with certain carriers
- Mid-level providers needed supervision documentation that wasn’t consistently maintained
The financial impact was severe. With providers unable to bill certain insurance plans, the group was turning away patients or scheduling them with providers who were already overbooked. They estimated losing approximately $85,000 monthly in potential revenue due to credentialing delays. When they did onboard new clinicians, the delayed credentialing meant those providers weren’t generating enough revenue to justify their salaries for the first several months.
Staff morale had taken a hit too. Newly hired therapists felt frustrated sitting around waiting for approval to see certain patients. The office manager was working 60-hour weeks just trying to keep up with credentialing applications and was on the verge of quitting. The clinical director spent hours each week fielding calls from insurance companies asking for clarification on applications, time she should have spent on clinical supervision and quality improvement.
The group had tried several solutions. They attempted to hire a second administrative person specifically for credentialing, but that person quit after three months because the job felt overwhelming. They looked into credentialing software, but the programs they found didn’t actually do the work, they just organized information that still needed manual entry into each payer’s portal. They considered credentialing services but worried about cost and losing control of their processes.
The Solution: Outsourcing to Credentialing Specialists
That’s when they reached out to us Medwave. We specialize in credentialing services for healthcare providers, including behavioral health practices with multiple practitioners across various license types and locations.
Our first step was conducting a thorough audit of their current credentialing status. We requested access to all existing provider files, insurance contracts, and pending applications. What we found was messier than the group had realized. Several providers had applications that had been denied weeks ago, but nobody had noticed because the denial notices went to an old email address. Three clinicians were practicing under credentialing that had actually expired months earlier, a serious compliance violation. Multiple applications had been submitted with errors that would inevitably lead to rejections.
We immediately took over all credentialing functions.
Here’s how we structured the process:
Initial Provider File Build-Out
For each of the 47 providers, we created detailed credentialing files containing every document they’d need for any application.
This included:
- Professional licenses (and verification that they were current)
- DEA certificates for prescribers
- Educational transcripts and diplomas
- Board certification documents
- Malpractice insurance certificates
- Professional liability claims history
- Work history for the past 10 years
- Professional references
- Hospital privileges documentation where applicable
- State-specific attestation forms
- Supervision agreements for provisionally licensed clinicians
Payer Relationship Management
We cataloged all existing payer relationships and identified which providers were credentialed with which plans. Then we created a priority matrix based on the group’s patient population and insurance mix. We determined which payers were most critical for each location and each provider type.
We established direct relationships with credentialing coordinators at each insurance company. This gave us insider knowledge about each payer’s specific requirements, typical processing timelines, and common reasons for delays. We also learned which payers would accept expedited processing requests and under what circumstances.
Application Submission and Follow-Up
We began systematically submitting new credentialing applications for all providers who had incomplete network participation. Rather than submitting everything at once and creating chaos, we prioritized based on financial impact and patient need.
For each application, we:
- Verified every field before submission
- Included all required attachments and supporting documentation
- Submitted through the correct channels (some payers use CAQH, others require direct portal submission, some still use paper applications)
- Documented submission dates and confirmation numbers
- Set up tickler reminders for follow-up at specific intervals
Our follow-up process was aggressive but professional. We contacted each payer at the two-week mark to confirm receipt and verify the application was in process. We reached out again at 30 days, 60 days, and 90 days until approval came through. When payers requested additional information, we turned it around within 24-48 hours rather than letting weeks pass.
State-Specific Processing
We managed the different requirements for Pennsylvania and New Jersey separately. Each state required different license verification processes, and some payers had different credentialing departments for each state. We ensured that providers who worked at multiple locations had appropriate credentialing for the states where they practiced.
Recredentialing Calendar Management
We built a master calendar tracking every providers’ recredentialing dates with every payer. Credentialing typically needs renewal every three years, but the dates vary by payer and provider. We set reminders to begin re-credentialing processes 120 days before expiration dates, ensuring no provider would ever practice with expired credentials again.
Ongoing Provider Onboarding
As the group hired new clinicians, we integrated them into our credentialing process immediately. New hires received a welcome packet explaining the credentialing timeline and what to expect. We collected all necessary documentation during their first week and began applications right away. We kept both the provider and practice leadership updated on progress through regular status reports.
The Results: Operational Efficiency and Revenue Recovery
Within 120 days, we had cleared the credentialing backlog. All 47 providers were fully credentialed with their priority payers. The 12-18 providers who had been waiting for credentialing completion were now able to see patients across all relevant insurance plans.
The timeline improvements were dramatic. Before working with Medwave, the average credentialing application took 4-6 months from start to finish. We reduced that to 60-90 days for most payers, and for urgent situations, we’d successfully expedited applications to 30-45 days.
The financial impact was immediate and measurable. With all providers able to bill all relevant insurance plans, the group recovered that lost $85,000 monthly revenue within the first quarter. Over a year, this represented more than $1 million in revenue that would have been lost to credentialing delays.
Beyond the numbers, the operational improvements changed how the practice functioned:
- The office manager no longer spent 60-hour weeks on credentialing.
We freed up approximately 40 hours weekly of administrative time that could be redirected to patient care coordination, staff support, and practice development. - New providers became productive faster.
Instead of sitting idle for months, newly hired clinicians could begin seeing their full patient panel within 60-90 days of starting. This improved both revenue per provider and staff satisfaction. - The compliance risk disappeared.
No provider was practicing with expired credentials. All documentation was current and organized. If a payer or regulatory body requested verification of credentialing status, we could provide it immediately. - Leadership gained visibility into credentialing status across their entire organization.
They received monthly reports showing exactly where each provider stood with each payer, which applications were pending, and when re-credentialing would be needed. This allowed for better strategic planning around hiring and network participation. - The practice could pursue new payer contracts more confidently.
When they identified a gap in their insurance coverage, such as a regional employer’s health plan that many potential patients carried, they could approach that payer knowing we could handle the credentialing for all 47 providers efficiently. - Patient access improved significantly.
The practice could tell new patients calling for appointments that they accepted their insurance without having to add the qualifier “but it might be a few months before we can see you.” This reduced patient frustration and helped the group capture more of the demand in their market.
Lessons for Other Behavioral Health Groups
This behavioral health group’s experience illustrates several important points about credentialing for multi-provider practices:
- Credentialing is specialized work that requires dedicated expertise and time. As practices grow beyond a few providers, expecting in-house administrative staff to handle this function alongside their other duties becomes unrealistic.
- Different license types require different credentialing approaches. A practice with psychiatrists, psychologists, social workers, counselors, and nurse practitioners can’t use a one-size-fits-all credentialing process.
- Multi-state operations multiply the difficulty. Each additional state means new licensing requirements, different payer processes, and separate compliance obligations.
The cost of credentialing delays far exceeds the cost of a professional credentialing service. This group was losing $85,000 monthly before bringing in help. The investment in outsourced credentialing paid for itself many times over.
Let Medwave Handle Your Credentialing Challenges
At Medwave, we provide billing, credentialing, and payer contracting services specifically designed for healthcare providers who need expert support with insurance administrative functions. We’ve helped behavioral health practices of all sizes, from solo practitioners to large multi-specialty groups, establish and maintain effective credentialing processes.
If your practice is struggling with credentialing delays, application errors, or the administrative burden of managing multiple providers across different insurance networks, we can help. Our team has established relationships with major insurance carriers and knows exactly what each payer requires for smooth credentialing. We handle the details while you focus on delivering quality patient care.
Reach out today to learn how Medwave can transform your credentialing process from a bottleneck into a streamlined operation that supports your practice’s growth.