The Initial Request
A behavioral health practice approached Medwave with a specific need. Credentialing services that could handle their six-state telehealth operation. What started as a simple inquiry revealed a much bigger story about the real-world challenges of expanding virtual care across state lines and the administrative burden that comes with it.
The practice had grown rapidly over the past two years, riding the wave of increased demand for virtual mental health services. What began as a small group practice serving patients in one state had transformed into a regional telehealth provider operating across six states in the Southeast. While the clinical team excelled at delivering care, the administrative side was drowning in credentialing paperwork, state licensing requirements, and payer enrollment applications.
The Situation They Faced
When the practice first started offering telehealth services, they assumed credentialing would work the same way it did when they only saw patients in person. They quickly learned otherwise. Each state where they provided services had different licensing requirements. Each insurance company had its own credentialing process. And every payer wanted documentation verified in specific ways.
The practice employed eight therapists and two psychiatrists, all of whom needed to be credentialed in multiple states. Some providers held licenses in three states. Others had licenses in five. Keeping track of which provider could see patients in which state, through which insurance plans, became a full-time job in itself.
Their office manager, who had been handling credentialing along with her other duties, was spending 25 to 30 hours per week just on credentialing tasks. She was constantly chasing down documents, following up with insurance companies, tracking application status, and fielding questions from providers about why they couldn’t see certain patients yet.
Applications were taking four to six months to process. During that time, the practice couldn’t bill those insurance plans for services. They either had to turn away patients or see them at significantly reduced self-pay rates. The revenue impact was substantial, but the bigger problem was the missed opportunity to serve patients who needed care.
Why Multi-State Credentialing Gets Complicated
Telehealth sounds simple in theory. A provider logs into a video platform, a patient logs in from their home, and they have a therapy session. But from a credentialing and regulatory standpoint, it creates a web of requirements that can overwhelm even experienced administrators.
Firstly, there’s state licensing. Most states require healthcare providers to hold an active license in the state where the patient is located during the telehealth visit. So a therapist providing services to patients in six states needs six separate state licenses. Each state has its own application process, fees, continuing education requirements, and renewal schedules.
Then comes credentialing with insurance plans. Just because a provider is credentialed with Blue Cross Blue Shield in one state doesn’t mean they’re automatically credentialed with Blue Cross Blue Shield in another state. Each state often has different Blue Cross Blue Shield entities, each requiring separate credentialing applications.
The practice was dealing with credentialing requirements from approximately 45 different insurance plans across their six states of operation. Some payers had streamlined processes. Others required extensive documentation going back ten years. A few had online portals that worked well. Many still relied heavily on fax and mail communication.
CAQH ProView helped to some degree, but it wasn’t the complete solution they had hoped for. While it did allow them to enter provider information once and share it with multiple payers, not all insurance companies pulled from CAQH regularly. Some still wanted paper applications. Others had questions about specific entries and required additional documentation.
The Impact on Practice Operations
The credentialing backlog was creating real operational problems. The practice had to maintain a detailed spreadsheet tracking which providers were credentialed with which plans in which states. Before scheduling any patient, staff had to verify that the assigned provider was actually credentialed to see that patient based on their insurance and location.
Mistakes happened. A patient would schedule an appointment, attend the session, and then weeks later the practice would discover the claim was denied because the provider wasn’t credentialing with that specific plan in that specific state. This created awkward conversations with patients about unexpected bills and damaged the practice’s reputation.
The practice was also losing out on new provider recruitment. They wanted to hire two additional therapists to meet growing demand, but the thought of adding two more providers to their already overwhelming credentialing workload made them hesitate. Growth was being constrained by administrative capacity rather than clinical need or market opportunity.
Provider morale was suffering too. Therapists wanted to focus on helping patients, not worrying about which insurance plans they could bill in which states. When they had openings in their schedule but couldn’t fill them because credentialing wasn’t complete, frustration grew. Some providers were questioning whether the multi-state model was worth the hassle.
The financial impact was measurable. Based on their analysis, the practice estimated they were losing approximately $35,000 per month in potential revenue due to credentialing delays. Patients who couldn’t be seen through insurance either went elsewhere or paid reduced self-pay rates. For a growing practice trying to invest in better technology and competitive salaries, this lost revenue mattered.
What They Tried Before Reaching Out
The practice didn’t immediately look for outside help. Like many healthcare providers, they first tried to solve the problem internally.
They created detailed checklists for each credentialing application, thinking better organization would solve the problem. It helped somewhat, but the sheer volume of applications still overwhelmed their administrative team.
They considered hiring a full-time credentialing specialist. After running the numbers, they realized a full-time employee with benefits would cost them roughly $50,000 to $60,000 per year. That person would still need training on the specific requirements of each state and payer. And if that person left, they’d be back to square one.
They tried using credentialing software to track applications and deadlines. The software did help with organization, but it didn’t actually complete the applications or follow up with insurance companies. It was a tool, not a solution.
Some providers in the practice had suggested just focusing on fewer insurance plans or operating in fewer states. But the practice leadership knew that limiting their network would mean turning away patients who needed care. Their mission was to increase access to mental health services, and restricting which patients they could serve felt like moving backward.
The Search for Credentialing Support
After months of struggling with the workload, the practice decided to look for a credentialing service that could handle their multi-state operation. They had specific criteria in mind.
They needed a service with real experience in telehealth credentialing across multiple states, not just someone who worked with traditional in-office practices. The requirements were different, and they wanted a partner who already knew those differences.
They wanted transparent communication about timelines and status updates. Their office manager was tired of submitting applications into a black hole and not knowing whether they were being processed or stuck somewhere in the system.
They needed a service that could handle the full scope of their operation, not just help with a few applications. With ten providers, six states, and 45+ payer relationships, they needed someone who could manage the entire credentialing operation.
Cost was important, but it wasn’t the only factor. They had received quotes from services that seemed cheap initially but had hidden fees for expedited processing, additional states, or revalidation. They wanted clear, predictable pricing.
They also wanted to work with a company that offered more than just credentialing. They knew that payer contracting and rate negotiations would become important as they grew. Finding a partner who could help with those areas down the road made sense.
The Solution Approach
When the practice connected with us at Medwave, the initial conversation focused on truly grasping the scope of their situation. Rather than offering a one-size-fits-all package, the team took time to map out exactly what needed to happen.
They identified the providers needing credentialing in which states and with which payers. They prioritized based on patient demand and revenue potential. Some payer-state combinations would generate significant volume. Others were nice to have but not critical.
Medwave’s team created a phased implementation plan. Rather than trying to submit all applications at once and hoping for the best, they developed a strategic sequence. High-priority credentialing applications went first. As those were approved, the next tier would begin.
The plan included setting up proper CAQH profiles for all providers and ensuring they were complete and accurate. This foundational work would streamline many of the subsequent payer applications.
For states where providers didn’t yet have licenses but wanted to practice, the plan included applying for appropriate state licenses before starting the credentialing process with payers in those states. There was no point in getting credentialed with insurance plans in a state where the provider couldn’t legally practice.
The team also addressed revalidation. They created a calendar showing when each provider’s credentials would need revalidation with each payer. This forward-looking approach meant the practice would never again be caught off guard by expiring credentials.
Implementation and Results
The first 90 days focused on getting the foundation right. All provider CAQH profiles were updated and verified. Missing documentation was tracked down and uploaded. State license applications were submitted where needed.
During months two and three, the bulk of the initial credentialing applications went out. The practice received regular updates on application status, which payers had requested additional information, and what the expected approval timelines looked like.
By month four, approvals started coming through. The first wave of credentialing completed included the highest-priority payer-state combinations. Providers could now see patients with those insurance plans, and claims started processing properly.
By month six, approximately 75% of the targeted credentialing applications had been approved. The practice was seeing a measurable increase in billable sessions because providers could now accept patients they previously had to turn away.
The office manager reported that credentialing tasks that used to consume 25 to 30 hours of her week now took about two to three hours. She was mainly handling questions from providers and coordinating information sharing with the credentialing team. The heavy lifting of applications, follow-up, and tracking had shifted off her plate.
The practice was able to move forward with hiring the two additional therapists they had been putting off. With credentialing support in place, onboarding new providers became manageable rather than overwhelming.
Revenue increased as well. Within six months of working with Medwave, the practice saw approximately $28,000 per month in additional revenue from patients they could now see through insurance rather than at reduced rates or not at all. The credentialing service essentially paid for itself through increased collections.
Lessons from the Experience
Looking back, the practice leadership identified several things they would have done differently if they could start over.
They would have sought credentialing support much earlier. Waiting until the problem became critical meant they operated for months at reduced capacity and lost significant revenue. Getting help when they first started expanding beyond their home state would have prevented much of the struggle.
They would have been more strategic about which states to enter and when. Rather than trying to serve patients in six states all at once, a phased approach to geographic expansion would have been more manageable. Getting fully credentialed in two or three states first, then expanding to additional states, would have created a smoother growth path.
They would have built better tracking systems from the beginning. Even with credentialing support, practices need internal systems to know which providers can see which patients. Setting up these systems early prevents billing errors and patient scheduling mistakes.
They also learned the value of thinking about credentialing and payer contracting together. Once their providers were credentialed with various insurance plans, the next question became whether the contracted rates were fair. Having a partner like Medwave who handles both credentialing and payer contracting meant they could address both issues with one relationship.
Key Factors That Made the Difference
Several specific elements contributed to the positive outcome in this situation:
- Experience with telehealth: The credentialing team had worked with other multi-state telehealth operations before. They knew which payers had specific telehealth requirements and which states had unique licensing rules for virtual care. This experience prevented rookie mistakes and delays.
- Clear communication: Regular status updates kept everyone informed. The practice leadership always knew where things stood rather than wondering whether applications were progressing or stuck.
- Strategic prioritization: Not all credentialing applications were equally important. Focusing on high-impact payer-state combinations first delivered results faster and improved cash flow more quickly.
- Proper documentation: Getting provider files organized and complete from the start prevented the endless back-and-forth requests for additional information that slow down credentialing.
- Ongoing support: Credentialing isn’t a one-time project. New licenses need to be obtained, existing credentials need revalidation, and providers change over time. Having ongoing support rather than project-based help made the long-term difference.
The Broader Picture
This practice’s story illustrates what many telehealth providers face as they scale across state lines. The clinical model of virtual care is relatively straightforward. The administrative reality is anything but simple.
Each state has its own rules. Each payer has its own process. Each provider has unique documentation needs. Multiply this by six states, 45 insurance plans, and ten providers, and you get hundreds of individual applications and thousands of specific requirements to track.
For practices that want to focus on patient care rather than administrative paperwork, partnering with specialists who handle credentialing makes practical sense. The cost of credentialing services is typically far less than the cost of lost revenue from credentialing delays, staff time spent on applications, or mistakes that lead to claim denials.
At Medwave, we work with healthcare providers across specialties to handle medical billing, credentialing, and payer contracting. For multi-state telehealth operations, we bring specific experience with the unique requirements that virtual care creates. We handle the details so providers can focus on what they do best: taking care of patients.
What This Means for Other Telehealth Practices
If you’re running a telehealth operation across multiple states, this practice’s experience probably sounds familiar. The good news is that these challenges are solvable with the right approach and support.
Start by getting clear on your actual needs. Which states do you want to operate in? Which insurance plans are most important for your patient population? Which providers need credentialing where? Having this clarity helps you build a realistic plan rather than trying to do everything at once.
Don’t wait until the credentialing backlog becomes a crisis. If you’re already feeling overwhelmed, it’s time to get help now. If you’re just starting to expand, getting support early prevents problems before they start.
Look for credentialing partners with specific telehealth experience. The requirements differ from traditional in-office practice credentialing, and working with someone who already knows those differences saves time and prevents mistakes.
Build internal systems to track credentialing status and provider eligibility. Even with great external support, your practice needs to know which providers can see which patients at any given time.
Think long-term. Credentialing isn’t a one-time task. It’s an ongoing operational requirement. Finding a credentialing partner you can work with for years, not just for an initial project, creates stability and consistency.
Consider the full picture of billing, credentialing, and contracting. These three areas connect closely. Getting credentialed is step one. Getting paid properly requires effective billing. Getting paid fairly requires strong payer contracts. Working with a partner who handles all three creates continuity and better overall results.
The telehealth model offers tremendous potential to increase access to healthcare. Don’t let credentialing challenges hold your practice back from serving the patients who need you.