FAQ: Provider Credentialing Speed and Process

How Long Does Provider Credentialing Typically Take?

Standard provider credentialing takes 90 to 120 days with most insurance companies. Medicare enrollment through PECOS typically requires 60 to 90 days. Medicaid processing times vary significantly by state, ranging from 30 days to 120 days. Commercial payers like UnitedHealthcare, Anthem, and Cigna generally process applications within 90 to 120 days, though some can extend to 150 days.

However, practices that implement the right strategies can reduce these timelines significantly. By starting the process early, maintaining complete documentation, and following up consistently, many practices get their priority payers approved within 60 days. The key is not waiting for every single payer to approve before the provider starts generating revenue, but rather focusing on high-volume payers first.

Can You Bill Insurance Before a Provider is Fully Credentialed?

Most insurance companies do not allow billing for services before credentialing is complete. However, several options exist to generate revenue during the credentialing period. Some payers offer backdating of the effective date, meaning they’ll reimburse for services provided during the final weeks of the credentialing process once approval is granted. This policy varies by payer, so you need to ask specifically about backdating when you submit applications.

Incident-to billing provides another option in certain situations. If a credentialed provider supervises the new provider, you may be able to bill under the supervising provider’s credentials. This requires the supervising provider to be present in the office and immediately available, and it only works for established patients with existing treatment plans. Locum tenens arrangements offer a third alternative, where you temporarily credential the provider through a staffing agency while permanent credentialing processes. Each of these approaches has compliance requirements that must be followed carefully.

What Documents Do You Need to Credential a Provider Quickly?

Fast credentialing starts with having complete documentation ready before you submit any applications. You’ll need the provider’s medical degree and transcripts from their medical school. Current state medical licenses for every state where they’ll practice are essential, along with their DEA certificate if they’ll prescribe controlled substances.

Board certifications in their specialty must be current and verifiable. Malpractice insurance declarations showing both current coverage and historical coverage for the past several years are required. A detailed work history covering the past 10 years with no gaps is critical, including contact information for each employer. Professional references, hospital privileges documentation if applicable, and immunization records round out the essential documents. Having all of these gathered and organized in digital format before starting the CAQH ProView profile saves weeks of back-and-forth requests.

What is CAQH ProView and Why Does It Matter for Credentialing Speed?

CAQH ProView is a centralized database where providers store their credentialing information once, and multiple insurance companies can access it for verification. Instead of filling out the same information on 20 different payer applications, you complete one detailed profile that serves as the foundation for all your credentialing applications.

The reason this matters for speed is simple. Most commercial insurance companies won’t begin processing your credentialing application until they can access a complete, attested CAQH profile. If you submit an application before the CAQH profile is ready, your application sits in a pending queue waiting. The insurance company doesn’t tell you this is the holdup. They just mark it as “in process” while nothing actually happens. Completing the CAQH profile first, then submitting payer applications, eliminates this major bottleneck. The profile must be re-attested every 120 days to stay active, so set calendar reminders to maintain it.

Should You Apply to All Insurance Companies at Once or Prioritize Certain Payers?

Prioritizing payers makes far more sense than trying to credential everywhere simultaneously. Start by identifying your top five insurance companies based on patient volume and revenue. These priority payers should receive applications first, with your full attention on moving them through the process quickly.

Getting approved by your highest-volume payers within 60 days means your provider can start billing for 70% to 80% of their potential patient base. This generates revenue while you work on secondary payers over the following 30 to 60 days. When you try to credential with 15 payers at once, your staff gets overwhelmed, follow-up becomes impossible to manage, and every application moves slower. Sequential prioritization with focused effort produces faster real-world results than scattered simultaneous applications.

How Much Does It Cost to Credential a Provider?

In-house credentialing costs vary based on staff time invested. If you’re doing everything manually, expect 40 to 60 hours of staff time per provider to handle initial credentialing with 10 to 15 payers. At an average credentialing coordinator salary, that’s roughly $1,200 to $1,800 in direct labor costs, not counting overhead or the opportunity cost of what else that person could be doing.

Credentialing management software costs $100 to $300 per provider per month depending on features and the number of providers you’re managing. Professional credentialing services typically charge $1,500 to $3,000 per provider for initial credentialing across multiple payers. While this seems expensive, consider that every week of delay costs approximately $10,000 in lost revenue for a full-time provider. Spending $2,000 to cut four weeks off your credentialing timeline means you’re saving $30,000 in opportunity cost. The return on investment for professional help is usually clear when you run the numbers.

What Are the Most Common Mistakes That Delay Provider Credentialing?

Incomplete applications cause more delays than any other issue. Leaving fields blank, providing inconsistent information across forms, or failing to explain gaps in work history will get your application sent back for corrections. This adds two to four weeks to your timeline immediately. Always fill out every field, even if you write “N/A” for questions that don’t apply.

Missing or expired supporting documents create another major credentialing bottleneck. Submitting an application with an expired license, outdated malpractice insurance, or board certification that needs renewal means the payer pauses your application until you provide current documents. Check expiration dates on everything before you submit. Failing to follow up consistently is the third big mistake. Applications that don’t get weekly status checks sit in queues longer than applications where someone is actively calling for updates.

When Should You Start the Credentialing Process for a New Provider?

Start credentialing before the provider’s official start date at your practice. Ideally, begin collecting required documents when you extend the job offer. This gives you 30 to 60 days of lead time to get organized before the provider even walks through your door on day one.

The moment you have a signed offer letter, request all credentialing documents from the provider. Set up their CAQH ProView profile as soon as you have the basic information and supporting documents. You can’t submit most payer applications until the provider is officially employed, but you can complete 80% of the preparation work beforehand. When their start date arrives, you’re ready to submit applications immediately instead of spending the first two weeks gathering paperwork. This head start can reduce your overall credentialing timeline by 30 to 45 days.

Can Credentialing Be Expedited with Insurance Companies?

Some insurance companies offer expedited credentialing in specific situations, though it’s not universally available. Providers joining practices in areas with documented provider shortages may qualify for fast-track processing. Telemedicine providers sometimes receive expedited review since they’re not tied to specific physical locations.

Certain healthcare specialties with limited availability in a region can leverage expedited processing, especially if the insurance company is facing network adequacy requirements. You won’t know if expedited processing is available unless you ask directly when submitting the application. Call the credentialing department, explain your situation, and specifically request expedited review if any special circumstances apply. The worst they can say is no, but you’d be surprised how often they can accommodate the request if you’re credentialing in a needed specialty or underserved area.

What’s the Difference Between Initial Credentialing and Recredentialing?

Initial credentialing is the full verification process when a provider first enrolls with an insurance company. The payer verifies education, licenses, certifications, work history, and background checks from scratch. This takes 90 to 120 days on average because every piece of information requires independent verification.

Recredentialing occurs every three years for most payers. Since the provider is already in their system, the process focuses on verifying that credentials remain current and checking for any new issues like malpractice claims or license actions. Recredentialing typically takes 60 to 90 days. The key difference is that recredentialing builds on existing verified information rather than starting from zero. However, missing a recredentialing deadline can result in termination from the network, forcing you to go through initial credentialing again, so tracking these three-year cycles is critical.

Should Small Practices Outsource Credentialing or Handle It In-House?

The decision depends on your practice size, staff expertise, and provider turnover rate. If you’re adding one provider every two years and have an experienced administrative person with extra capacity, in-house credentialing might work fine. However, if you’re adding multiple providers annually, dealing with credentialing delays, or lacking staff with specific credentialing knowledge, outsourcing makes financial sense.

Calculate the true cost of in-house credentialing including staff time, software, training, and most importantly, the revenue lost during extended credentialing periods. When a provider sits idle for an extra month because your in-house team is overwhelmed or inexperienced, that’s $20,000 in lost revenue. Professional credentialing services cost $1,500 to $3,000 per provider but often reduce timelines by 30 to 60 days. The revenue protected typically exceeds the service cost by a significant margin. Many practices find a hybrid model works best, where they handle routine maintenance in-house but outsource initial credentialing for new providers.

How Do You Track Credentialing Status Across Multiple Insurance Companies?

Effective tracking requires a centralized system where you can see the status of every application at a glance. At minimum, create a spreadsheet with columns for provider name, insurance company, application submission date, confirmation number, current status, next follow-up date, and notes from conversations. Update this weekly based on your status calls.

Credentialing management software offers more robust tracking with automated alerts, dashboard views, and integration with payer portals. These systems send reminders when it’s time to follow up, flag applications that are taking longer than expected, and store all correspondence in one location. Regardless of whether you use software or spreadsheets, the critical factor is having one source of truth that multiple team members can access. When credentialing information lives in someone’s email inbox or on scattered sticky notes, timelines extend and details get lost.

What Happens if a Credentialing Application Gets Rejected?

Application rejections typically occur for correctable reasons rather than disqualifying issues. Common rejection causes include incomplete information, inconsistent details between your application and CAQH profile, missing supporting documents, or using an outdated application form. When you receive a rejection notice, it usually explains exactly what needs to be fixed.

Correct the identified issues immediately and resubmit within 24 to 48 hours if possible. The faster you respond, the faster your corrected application moves back into the review queue. In most cases, fixing the problems and resubmitting adds two to four weeks to your timeline. This is frustrating but not catastrophic. True disqualifications based on license issues, serious malpractice history, or background check problems are much rarer than simple administrative rejections. Keep copies of all rejection notices and your corrected resubmissions for your records.

Can You Credential Providers in Multiple States Simultaneously?

Yes, multi-state credentialing is absolutely possible and often necessary for practices with multiple locations or telehealth providers. The key is ensuring the provider holds active licenses in every state where they’ll practice before you begin the credentialing process. You cannot credential in a state where the provider isn’t licensed.

The CAQH ProView profile supports listing multiple state licenses, which streamlines multi-state credentialing. When you apply to payers, you specify which states the provider will work in, and the insurance company credentials them for those specific locations. Multi-state credentialing doesn’t necessarily take longer than single-state credentialing, but it does require more careful tracking since each state may have slightly different requirements or processing timelines. The Interstate Medical Licensure Compact helps physicians obtain licenses in multiple states more efficiently, which can speed up the overall multi-state credentialing process.

How Does Credentialing Affect Provider Recruitment and Retention?

Long credentialing delays frustrate new providers and cost your practice money from day one. Providers expect to start seeing patients and earning income shortly after joining a practice. When credentialing drags on for four months because of administrative delays, you risk losing quality candidates who accept offers elsewhere or having new hires arrive with immediate dissatisfaction.

Fast, efficient credentialing demonstrates organizational competence to new providers. It shows you value their time and understand the business side of medicine. Practices known for quick credentialing have a competitive advantage in recruiting. They can honestly tell candidates they’ll be seeing patients and billing within 60 days rather than the typical 120-day wait. This matters to providers evaluating multiple job offers. Additionally, delays in credentialing affect your ability to expand services or fill urgent staffing needs. The faster you can get provide

Ready to Speed Up Your Provider Credentialing Process?

Credentialing doesn’t have to take four months and cause constant headaches. With the right approach, complete documentation, and consistent follow-up, you can get your providers enrolled and billing within 60 days for most major payers.

If you’re tired of credentialing delays cutting into your revenue or you don’t have staff with the expertise to manage this process efficiently, Medwave can help. Our credentialing specialists handle everything from document collection through final approval, using proven strategies to reduce timelines and eliminate common errors.