Provider credentialing is a critical step for any healthcare practice, yet it’s one of the most commonly mismanaged processes. Delays in credentialing can cost practices thousands of dollars in lost revenue and prevent patients from accessing care. Understanding the most frequent mistakes can help you avoid costly setbacks and get your providers enrolled faster.
Mistake 1: Incomplete or Inaccurate Applications
One of the primary reasons for credentialing delays is submitting incomplete applications. Missing documents, unsigned forms, or incorrect information force payers to send applications back for correction. This can add 30-60 days to your timeline. Always double-check that all required fields are completed, supporting documents are attached, and signatures are obtained before submission.
Mistake 2: Outdated CAQH Profiles
Many providers forget to update their CAQH ProView profiles regularly. Insurance companies pull data directly from CAQH, and if your profile is outdated or not attested within the required 120-day window, your application will be delayed. Set calendar reminders to review and attest your CAQH profile quarterly to avoid this common pitfall.
Mistake 3: Missing or Expired Documents
Credentialing applications require numerous supporting documents including medical licenses, board certifications, DEA certificates, malpractice insurance, and professional references. If any of these documents are missing, expired, or nearing expiration, your application will be held up. Maintain a centralized file of all credentialing documents and monitor expiration dates proactively.
Mistake 4: Not Following Up with Payers
Submitting your application is just the beginning. Payers don’t always process applications on schedule, and they may have questions or need additional information. Providers who don’t follow up regularly may find their applications sitting in a queue for months. Contact payers every 10-14 days to check status, answer questions, and keep your application moving forward.
Mistake 5: Starting the Process Too Late
Perhaps the biggest mistake is waiting until the last minute to begin credentialing. If you’re opening a new practice, joining a group, or moving to a new state, start the credentialing process at least 6 months in advance. This buffer allows time for unexpected delays while ensuring you can begin seeing patients and receiving reimbursements on schedule.
Conclusion
Avoiding these five common credentialing mistakes can significantly reduce enrollment delays and get your providers seeing patients sooner. If managing credentialing feels overwhelming, consider partnering with an experienced RCM company like MedNexa Health. Our credentialing specialists handle the entire process from start to finish, ensuring accurate applications, timely follow-ups, and faster payer approvals. Contact us today to learn how we can streamline your credentialing process.
