When this behavioral health group first contacted Medwave, its office manager was spending 25 to 30 hours a week on credentialing on top of her regular job. The practice had 10 providers seeing telehealth patients in six Southeastern states, roughly 45 payer plans to keep straight, and new hires who waited four to five months before they could bill a single insurance plan. Six months into the engagement, her credentialing workload was down to two or three hours a week, and the practice was collecting about $28,000 more per month from insured patients it used to turn away.
Key Takeaways
- Ten providers, six states, and about 45 payer plans added up to hundreds of separate enrollments, each with its own documentation rules.
- The practice estimated that credentialing delays were costing it about $35,000 a month in billable sessions.
- Medwave ranked every provider, state, and payer combination by revenue impact and submitted applications in tiers, starting with CAQH cleanup and state licenses.
- By month six, about 75% of targeted applications were approved and monthly revenue was up roughly $28,000.
- The office manager’s credentialing time fell from 25 to 30 hours a week to two or three, a reduction of about 90%.
- With the backlog cleared, the practice hired the two therapists it had been putting off.
Where the Practice Started
The group began as a small in-person practice in one state. Over two years, demand for virtual mental health care pulled it into five more. By the time it reached out to Medwave, it employed eight therapists and two psychiatrists. Some held licenses in three states and others in five.
Credentialing had never been anyone’s full-time job. The office manager absorbed it along with the rest of her duties. Most weeks went to chasing documents, calling payers for status updates, and explaining to providers why certain patients still couldn’t be booked with them.
Payer applications were taking four to six months to clear. Until one did, the practice couldn’t bill that plan. Patients either went elsewhere or were seen at a reduced self-pay rate.
Why Six States Multiplied the Work
Most states require a clinician to hold a license in the state where the patient is located during the visit. A therapist with patients in six states needs six licenses, and each one comes with its own application, fees, continuing education requirements, and renewal date. Compacts like the Interstate Medical Licensure Compact can shorten the path for physicians, including psychiatrists, but each state still issues and renews its own license. Medwave keeps a running breakdown of which states participate in multi-state licensing models.
Payer enrollment doesn’t carry across state lines either. A provider credentialed with Blue Cross Blue Shield in one state is not automatically credentialed with Blue Cross Blue Shield in the next, because many states have separate BCBS entities with separate applications.
Across its six states, the practice was dealing with about 45 insurance plans. A few had portals that worked well. Many still ran on fax and mail, and some wanted documentation going back ten years. CAQH ProView let the practice enter provider data once, but not every payer pulled from it regularly, and several still required their own paper applications.
What the Backlog Cost
Staff kept a spreadsheet showing which provider was credentialed with which plan in which state. Every new appointment had to be checked against it before booking. When a check was missed, the claim came back denied weeks later because the provider wasn’t credentialed with that plan in that state. The practice then had to call the patient about a bill they hadn’t expected.
Growth stalled as well. Leadership wanted two more therapists to keep up with demand, but adding two more credentialing files to an already overloaded desk felt like a bad trade. Clinicians with open slots they couldn’t fill grew frustrated, and a few started asking whether the multi-state model was worth it.
The practice put the cost of these credentialing delays at about $35,000 a month in lost revenue. That was money it had planned to spend on better technology and competitive salaries.
What They Tried First
The practice tried to fix it in-house before looking outside.
Detailed checklists for each credentialing application helped with organization, but the volume still buried the admin team.
Hiring a full-time credentialing specialist would have cost $50,000 to $60,000 a year with benefits. That hire would still need training on every state’s and payer’s requirements, and the practice would be back where it started if that person left.
Credentialing software tracked deadlines well. It did not fill out applications or call payers.
Some providers suggested dropping plans or pulling out of states. Leadership said no, since the practice existed to widen access to mental health care.
What They Wanted in a Credentialing Partner
The practice was looking for a team with real telehealth credentialing experience across multiple states. A firm that mostly handled single-location, in-person practices wouldn’t know which payers treat virtual care differently.
The office manager wanted to stop submitting applications into a void, so regular status updates were a requirement. The partner also had to take on the whole operation of ten providers, six states, and more than 45 plans, not a handful of applications.
Pricing mattered, but predictability mattered more. Earlier quotes had looked cheap until the fees for expedited processing, additional states, and revalidation showed up. Leadership also knew that payer contracting and rate negotiations would come up as the group grew, and it preferred one partner who could handle those later.
How Medwave Sequenced the Work
The first conversations with our team went into mapping the problem. We listed every provider, every state they needed, and every payer they needed in each state. Then we ranked the combinations by patient demand and revenue potential. Some combinations drove most of the volume, while others could wait.
Applications went out in tiers instead of all at once. Before any payer submission, each provider’s CAQH profile was completed and verified, because a clean profile shortens most of the provider credentialing steps that follow. Where a provider needed a new state license, that application went first. Getting credentialed with a plan in a state where the provider can’t legally practice accomplishes nothing.
We also built a revalidation calendar showing when each provider’s credentials would come due with each payer. That calendar now drives the practice’s recredentialing so expiring enrollments don’t catch anyone off guard.
Month-by-Month Results
The first month went to groundwork. All provider CAQH profiles were updated and attested, missing documents were tracked down and uploaded, and state license applications were filed where needed.
Most payer applications went out in months two and three. The practice got regular updates on which payers had asked for more information and when approvals were expected.
Approvals started arriving in month four, beginning with the highest-priority payer and state combinations. Those providers could now see patients on those plans, and their claims processed normally.
By month six, about 75% of targeted applications were approved and the rest were still moving through payer queues. Monthly revenue was up roughly $28,000, which recovered most of the estimated $35,000 gap. The added collections more than covered the cost of the credentialing service.
The office manager’s credentialing time dropped from 25 to 30 hours a week to two or three, a cut of about 90%. What remained was answering provider questions and passing information to the Medwave team.
The practice also hired the two therapists it had been holding off on, bringing the group to 12 providers. Both were onboarded through the same process.
What Leadership Would Do Differently
Looking back, the practice’s leaders said they would have brought in credentialing help as soon as they crossed their first state line. Waiting until the backlog became a crisis meant months of reduced capacity and lost revenue.
They would also have expanded in phases. Getting fully credentialed in two or three states before adding more would have made for a much smoother ramp.
Internal tracking was another lesson. Even with outside support, the front desk needs to know which providers can see which patients on any given day, and setting that up early prevents denied claims and scheduling mistakes.
Finally, they came to see credentialing and contracting as one conversation. Once providers were in network, the next question was whether the contracted rates were fair. Having both handled by the same partner meant they didn’t have to start over with a new vendor to answer it.
What Made the Difference
Medwave’s team had worked with multi-state telehealth groups before. They knew which payers have telehealth-specific requirements and which states handle virtual care licensing differently, which kept the practice from losing months to avoidable rejections.
Sequencing mattered almost as much. Submitting the highest-revenue applications first meant cash flow improved months before the full backlog cleared, and complete provider files at the start cut out most of the back-and-forth requests that stall applications.
The work also didn’t stop at month six. Licenses renew, payers revalidate, and providers join and leave, so the practice moved to ongoing support instead of treating credentialing as a one-time project.
Telehealth Credentialing Case Study FAQ
What was the main credentialing problem this six-state telehealth practice faced before working with Medwave?
Ten providers licensed across six states needed to be enrolled with about 45 payer plans, and the work fell on an office manager who was spending 25 to 30 hours a week on it. Applications took four to six months, and the practice estimated it was losing about $35,000 a month because providers couldn’t yet bill their full payer panels.
How long did the credentialing engagement with Medwave take?
The initial engagement ran six months. Month one went to CAQH cleanup and state license applications, most payer applications went out in months two and three, approvals began in month four, and about 75% of targeted applications were approved by month six. Medwave also set up a revalidation calendar so future deadlines are tracked well ahead of time.
How much did the practice reduce internal credentialing admin time by?
About 90%. The office manager went from 25 to 30 hours a week on credentialing to two or three hours, mostly spent answering provider questions and passing information to Medwave.
How much revenue did the practice recover?
The practice had estimated a gap of about $35,000 a month from providers who couldn’t bill their full payer panels. By month six, monthly revenue was up roughly $28,000, with the remaining applications still in process.
Why was credentialing so difficult across six states for this practice?
Most states require a license where the patient is located during the visit, so providers needed a separate license for each state. Payer enrollment doesn’t transfer between states either, and many states have their own Blue Cross Blue Shield entity. Across about 45 plans, documentation rules and submission methods varied widely.
How long were new provider onboarding and payer applications taking before Medwave stepped in?
New provider onboarding took four to five months, and payer applications took four to six months to clear. During that wait the practice couldn’t bill those plans, so patients were turned away or seen at reduced self-pay rates.
What This Means for Other Telehealth Practices
If you run a telehealth operation across several states, parts of this story probably sound familiar.
Start by writing down which states you serve, which plans matter most to your patients, and which providers need to be enrolled where. That list becomes your submission order.
If the backlog is already slowing scheduling, get help now. If you’re about to add your second or third state, get it set up before the first new patient books.
Whoever handles your credentialing, keep your own record of provider eligibility by state and plan. Your schedulers need it every day, and it’s the first thing to check when a claim comes back denied.
Credentialing is only the first step toward getting paid. Because you can’t bill what you can’t credential, enrollment gaps show up later as billing problems, and contract rates decide what each approved enrollment is worth. Medwave handles medical credentialing, medical billing, and payer contracting under one roof, so a fix in one area doesn’t get lost in another.
Co-Founder and COO of Medwave, bringing more than 25 years of hands-on experience in healthcare revenue cycle management, payer contracting, and medical credentialing.