Credentialing Turnaround Time: Best Strategies for Faster Approvals

While provider credentialing is a critical first step before allowing medical providers to see patients, it often takes longer than expected, at an average of two to five months. 

Credentialing delays affect physicians and surgeons the most, making them lose up to $122,144 on average during the wait period. 

This article breaks down the credentialing turnaround time and the best practices to make the process as quick as possible.

How Long Does Credentialing Take?

Credentialing can take 60 to 180 days, with 90 to 120 days (3-4 months) being a common timeframe. It’s usually influenced by factors  such as:

• An organization’s efficiency
• Specific payer requirements
• State-specific requirements
• The complexity of the provider’s qualifications 

5 Key Steps in the Credentialing Process for Healthcare Providers

Credentialing process steps vary from one organization to another, but these are the key steps physicians must complete:

1. Application: Physicians must submit a complete application with detailed information about their education, employment history, medical staff privileges, and malpractice coverage
2. Supporting documents: This includes Drug Enforcement Administration (DEA) ID number, medical licenses, board certification, malpractice carrier, and health documentation
3. Verification: The healthcare organization then verifies the supporting documents by reaching out to the organizations or individuals directly
4. Approval: Once verification is complete, physicians are approved and enrolled in payer networks to begin billing for services and getting reimbursed
5. Recredentialing: Physicians must regularly update their credentials to reflect new qualifications, patient care milestones, and any additional training

This image summarizes the key steps:

Key Factors Affecting Credentialing Timelines

These four factors determine exactly how long credentialing will take.

1. Document verification

Primary source verification typically dictates the time required for credentialing, as all information must be fact-checked at the original source. Verification can be time-consuming, as healthcare organizations must communicate with various entities like educational institutions, licensing boards, and previous employers. Discrepancies or missing information often require additional follow-up, adding weeks or even months to the process.

2. Provider response times

Delays in provider responses can prolong the hospital credentialing process beyond what is expected. If providers take days or weeks to send the required information, the entire process stalls before it even begins. And if they are slow to respond to clarifications or requests for additional documentation, verifications can’t proceed. 

3. State and payer regulations

State laws for obtaining a license vary; some states approve applications quickly, while others have stricter checks and take longer. In Texas, credentialing can take up to 180 days, as physicians must submit the Texas Standardized Credentialing Application and undergo qualification checks. Insurance payers like Medicare and Medicaid also have their own approval procedures.

4. Credentialing team workflow efficiency

An efficient team significantly reduces credentialing turnaround time by minimizing errors, streamlining tasks, and communicating effectively. Teams with disorganized or manual processes can cause delays that prevent qualified physicians from seeing patients for weeks or months.

Average Timeframes for Different Types of Credentialing

The hospital credentialing process is tedious and resource-intensive, and timeframes differ depending on the specific credentialing type or healthcare organization. Here are the typical timeframes:

Top Challenges in the Credentialing Process

Credentialing challenges can significantly affect the turnaround time and decrease revenue for healthcare organizations. Here are the top challenges.

1. Data integrity problems

Some healthcare organizations still rely on manual data entry, which can result in compliance gaps. Issues such as data entry errors, outdated information, and inconsistencies across systems can significantly affect credentialing. When credentialing data is incorrect or incomplete, payers reject claims, and healthcare providers must correct and resubmit them.

2. Constantly changing compliance standards

Credentialing requirements vary across payer networks and states, making it difficult for organizations to remain compliant. Agencies such as The Joint Commission (TJC) and Centers for Medicare & Medicaid Services (CMS) frequently change policies, further complicating the process. Healthcare organizations must regularly re-verify provider information, update policies, and retrain staff to avoid costly penalties, claim denials, and legal risks.

3. Lengthy processing timelines

In most organizations, primary source verification takes between 60 and 180 days because it involves multiple verification steps. During this period, providers can’t see patients or bill for services. When hospital departments are understaffed, patients often have limited access to timely appointments and specialized care.

4. Lack of credentialing expertise

Many healthcare providers lack a dedicated credentialing team and struggle to navigate the complexities of credentialing. Recruiting qualified credentialing staff is costly, given the specialized nature of the role. Poor process management often results in denied applications, compliance risks, and lost revenue.

5. Navigating payer-specific requirements

One common credentialing challenge is obtaining payer approvals for providers to participate in insurance networks. Each payer has their own credentialing requirements, and healthcare organizations can’t create a standardized application process. Submitting incorrect or incomplete information to payers often leads to application rejections. 

Best Practices to Reduce Credentialing Time

While the provider credentialing process can be time-consuming, you can hasten it by applying these best practices. An organized framework for the credentialing process streamlines the process and reduces errors.

Have a standardized process

Establishing a standardized credentialing process helps you maintain accurate records and reduce the turnaround time. Define your onboarding process to ensure every healthcare provider follows the same procedure. Your process should outline the credentials to be verified, the required documents, and the frequency of verification. Also, ensure accountability and consistency by assigning specific roles and responsibilities to your credentialing team. 

Conduct primary source verification

Primary source verification accelerates credentialing timelines by verifying the authenticity of credentials upfront and minimizing rework. There are no costly delays or denials caused by inaccurate or missing information. Credentialing tools like PRIME® by Atlas Systems use APIs and integrations to deliver real-time data and alerts, enabling faster onboarding of qualified providers.

Perform regular audits

Timely audits help your medical organization stay compliant by catching credentialing mistakes early. Conduct regular audits of credentialing records to check for missing or outdated information. For example, you can set a quarterly audit schedule to identify expired credentials before they cause disruptions. This will ensure providers remain eligible to see patients and bill for services. 

Train credentialing staff

Training your credentialing team regularly ensures they consistently follow best practices. They should be aware of new compliance mandates and credentialing technologies. Also, adopt an organizational culture that prioritizes accuracy and attention to detail to significantly reduce credentialing errors. 

Use credentialing software

Credentialing software streamlines the process by automating repetitive tasks, such as document collection and tracking of license expirations. It minimizes errors related to manual data entry and creates a central document repository for all provider information. Built-in compliance tools continuously monitor provider credentials to ensure they are always up to date.

Technology Solutions That Streamline Credentialing

The shift from manual to digital credentialing has streamlined the process, significantly reducing credentialing turnaround time. Here are the top solutions that streamline credentialing.

Cloud computing

Cloud-based credentialing solutions offer remote access and automatic system updates, enabling healthcare organizations to stay current with ever-changing compliance requirements. The platforms reduce IT overhead and can scale to handle fluctuating data needs. They also ensure business continuity through cloud-based storage and backups.

Artificial Intelligence and Machine Learning

These two technologies add another layer of efficiency to the credentialing process. AI-powered tools can extract data, enter information across multiple systems, and handle status checks. Machine learning can identify anomalies, flag risky applications, and help prioritize verifications. Some credentialing tools use computer vision and OCR to verify signatures and protect against credential tampering. They also convert scanned documents into usable data. 

Blockchain 

Blockchain is increasingly being used in credentialing because it provides tamper-proof, digital records of provider credentials. The technology uses smart contracts to automate verification processes based on predefined rules. Credentials verification happens across a distributed blockchain network and isn’t the responsibility of a single organization or individual. Blockchain adds a level of trust and transparency and is particularly valuable in preventing fraud and ensuring regulatory compliance.

End Credentialing Delays with PRIME® By Atlas Systems

The healthcare industry is constantly evolving, and your credentialing process must keep pace. The right tool can streamline the process, making it faster, more accurate, and more efficient. Atlas Systems understands the importance of staying current with provider credentialing, training, and education. 

Our credentialing solution, PRIME®, eliminates inefficiencies and ensures that providers start practicing as soon as possible. By combining technology and smart processes, you can reduce your credentialing turnaround time significantly while maintaining high-quality standards.

See how much faster credentialing can be—try the Atlas PRIME® demo today. 

Frequently Asked Questions 

1. Why does credentialing take longer for certain hospitals, Medicare, or insurance plans?

Credentialing can take longer for some hospitals or insurance plans due to internal processes, requirements, and limited resources. Larger hospitals often have stricter compliance checks, which extend processing time. Similarly, Medicare and some insurance plans require additional documentation, background checks, or verifications, particularly for providers in high-risk specialties or those serving multiple states.

2. How can healthcare organizations track and improve credentialing timelines?

Healthcare organizations can improve credentialing timelines by using credentialing software that automates workflows and provides real-time reports on the status of each application, enabling easy identification of bottlenecks. These tools also integrate with healthcare systems such as EHRs, HR platforms, and insurance databases for seamless data exchange and to reduce duplication.

3. What role do credentialing services or software play in reducing delays?

Credentialing software reduces delays by automating time-consuming tasks such as data collection, application tracking, and reminders for expiring credentials. The platforms centralize all credentialing information, improving accuracy by minimizing human errors.

4. How can hospitals optimize their internal credentialing process?

Hospitals can optimize their internal credentialing process by using technology and standardizing workflows. This significantly reduces the onboarding time for providers, improving patient access and boosting revenue.