Medical credentialing is a must for healthcare providers, but the process can feel overwhelming. 

According to Medallion, 52% of healthcare organizations rely entirely on manual credentialing workflows. 

From paperwork to approvals, each step matters, and mistakes can lead to delays. 

So, how does it work? What do you need to get approved quickly?

Steps Of Medical Credentialing Process 

1. Identify the Required Documents 

Make a list of all the required documents before you start. These may include:

• Medical degrees from an approved school

• Residency program completion

• Active state medical license

• Board certification in a specialty

• Work history verification

2. Collect All Required Information

Gather complete details about the provider’s education, licenses, and past jobs. Missing details can slow things down, so make sure all documents are correct and updated.

3. Check Everything from the Original Source

Always verify information directly from the source. This means checking with medical schools, licensing boards, and past employers. Skipping this step can lead to approval issues later.

4. Keep Everything in One Place

Using a single system for storing and tracking documents makes the process easier. It helps keep deadlines in check and ensures nothing is lost or overlooked.

5. Use Technology to Speed Up the Process

Credentials can be verified more quickly with online systems. Digital tools make checking licenses and certifications quicker, which reduces long wait times.

6. Make Credentialing a Priority

Keep your paperwork organized. Set deadlines and make sure credentialing is handled on time. When it’s not a priority, it gets delayed, leading to bigger problems later.

7. Follow Up Regularly

Stay in touch with licensing boards and credentialing teams. Regular follow-ups avoid last-minute surprises and keep the process on track.

How Long Does the Credentialing Process Take?

The credentialing process usually takes between 60 to 90 days. However, the timeline can change based on different factors, such as:

• The number of applications the credentialing team is handling

• How complete and accurate the submitted documents are

• The response time of medical schools and licensing boards

• Delays can happen if there are missing details or slow responses from verification sources.

Challenges in the Medical Credentialing Process

The credentialing process comes with several challenges that can cause delays. Here are some common challenges and ways to overcome them:

1. Missing Information in Applications

Applications with missing details slow down the process. Credentialing teams must track down providers to get the needed documents. Reviewing applications before submission can prevent these delays.

2. Slow Verification from Primary Sources

Medical schools and licensing boards may take time to respond to verification requests. Following up regularly can help speed up the process.

3. Handling Credentialing for Multiple States

Providers working in different states must meet various requirements. Each state has different rules, making the process complicated. Using credentialing software can help track deadlines and keep documents organized.

4. Keeping Credentials Updated

After credentialing, providers must renew licenses and report any changes. If they don’t, they may lose their ability to practice. Using software can help manage renewals and avoid lapses.

Organizations and providers can handle credentialing more effectively if they are aware of these challenges.

Key Tips for a Faster Credentialing Process

Proper preparation can make credentialing quicker and easier. Follow these best practices:

1. Organize All Necessary Documents

Make sure you have all required records, including education certificates, training proofs, and licenses. Missing documents can cause unnecessary delays.

2. Work with Credentialing Specialists

Stay in touch with experts who handle credentialing. They can check for errors and ensure everything is correct before submission.

3. Keep Your Information Updated

Regularly review your credentials. If anything changes, update it right away to avoid any issues.

4. Use Credentialing Software

A digital tool can help store and manage your documents, making the process smoother.

Who Needs Credentialing?

Credentialing isn’t just for doctors. Many healthcare professionals must go through this process, including:

• Physicians (MD/DO)

• Physician Assistants

• Nurses

• Social Workers

• Mental Health Counselors

• Dentists

• Psychologists

Anyone providing direct patient care must be credentialed. Hospitals, clinics, and insurance companies require this before allowing providers to work with patients.

Credentialing Made Simple! We take care of the paperwork so you can focus on patients. Call us and schedule your free consultation! 

Conclusion

Outsourcing medical credentialing saves time and reduces errors. It allows organizations to focus on patient care while experts handle the process. With the right team, providers can ensure accuracy, stay compliant, and avoid delays. Working with credentialing professionals also brings advanced tools and industry knowledge, which makes the process faster and more efficient.

Need reliable medical credentialing services? We handle the process for you! Contact us today to get started.

FAQs

Is Credentialing Part of RCM?

Yes, credentialing is a part of Revenue Cycle Management (RCM). It helps get providers approved by payers, reducing claim denials and payment delays.

What Are The Types Of Credentialing?

It has different types:

• Primary Source Verification (PSV): Confirms education and licensure directly from issuing institutions.

• Insurance Credentialing: Verifies if providers meet payer requirements to join networks.

• Hospital Privileging: Allows providers to perform specific procedures at hospitals.

• Board Certification: A voluntary process proving expertise in a medical specialty.

• Mental Health Credentialing: Ensures therapists meet insurance standards for reimbursements.

What Documents Are Required For Credentialing? 

Healthcare providers need to submit several documents:

• Medical licenses

• DEA certificates

• Board certifications

• Educational records

• Work history 

• References

How Long Do I Need To Be Licensed To Get On Insurance Panels? 

It depends on the insurance company and state rules. Most fully licensed providers qualify, but some insurers require experience. 

Can New Providers Get Credentialed? 

Yes, but it depends on the payer. Some insurers allow newly licensed providers, while others require experience. Checking with each payer is the best way to confirm.

Does Credentialing Need To Be Renewed?

Yes, it’s not a one-time process. Providers must renew it regularly by updating their licenses, certifications, and other documents.

How Long Does Credentialing Take?

It typically takes 60 to 90 days. However, delays can happen if documents are missing or the verification process takes longer.

Can Outsourcing Help With Credentialing?

Yes! Outsourcing takes the stress off your plate. Experts handle the paperwork and follow-ups that make the process faster and error-free.

Is Re-credentialing The Same As Initial Credentialing?

Not quite. Initial credentialing is the first approval while re-credentialing keeps provider records up to date and ensures compliance.

How Often Do Credentials Need To Be Updated?

Most insurance companies require re-credentialing every two to three years. Keeping documents updated helps prevent delays and disruptions.