7 Ways Fast Provider Credentialing Gets Your Providers Seeing Patients (and Billing) Sooner

Healthcare administrators face an ongoing challenge: credentialing delays that prevent providers from seeing patients and billing for services. On average, according to MGMA, the credentialing process takes 90 to 180 days, leading to significant revenue loss, provider frustration, and patient care delays. Fast provider credentialing solutions can mitigate these issues effectively, ensuring your providers can quickly begin their work.

Imagine significantly reducing this time to 30 days or less through fast provider credentialing. At Fifth Avenue Healthcare Services, we’ve achieved this. Through our credentialing IPA, Primoris, using delegated credentialing, we have regularly completed provider enrollment in under 30 days. This means your providers can start seeing patients and billing for their services much faster, reducing revenue loss, provider frustration, and patient care delays.

Fast provider credentialing is essential in today’s healthcare landscape. With effective, fast provider credentialing practices, organizations can enhance service delivery and reduce operational bottlenecks.

Utilizing fast provider credentialing not only improves the workflow but also significantly boosts patient satisfaction. When providers are credentialed promptly, they can offer timely care and reduce the strain on existing staff.

If you’re searching for a better way to credential providers quickly and efficiently through fast provider credentialing, this article will break down the actual cost of slow credentialing, why traditional methods fail, and how you can get your providers credentialed faster—without frustration.

The Real Cost of Slow Credentialing

Every day a provider waits to be credentialed is a day of lost revenue. Here’s how it impacts healthcare organizations:

• Lost revenue per provider: A new provider unable to see patients for 60+ days can cost a medical practice hundreds of thousands of dollars in lost billing. Visit our credentialing lost revenue calculator for more.
• Patient access issues: Delayed credentialing means longer wait times for patients and increased workload for existing staff.
• Frustrated providers: Newly hired doctors may grow frustrated with bureaucratic delays, leading to dissatisfaction and even early departures.
• Operational inefficiencies: Administrative teams waste time and resources managing follow-ups with payers, verifying credentials manually, and dealing with avoidable delays.
• Risk of compliance issues: Delays in credentialing can also lead to compliance concerns, as uncredentialed providers may not be legally permitted to treat patients.
• Reputational damage: Consistent credential delays can impact your facility’s reputation, making it harder to attract top talent.

Slow credentialing doesn’t just affect your bottom line; it also has a significant impact on patient care. Implementing fast provider credentialing methods ensures that healthcare facilities can onboard new providers quickly, minimizing longer wait times for patients and allowing for timely access to specialists.

Additionally, healthcare organizations that consistently struggle with provider credentialing may face higher provider turnover rates. Physicians and healthcare practitioners expect efficient administrative support when joining a practice or hospital. If they perceive delays and inefficiencies as persistent, they may seek employment elsewhere, leaving healthcare organizations with increased recruitment costs and operational challenges.

With better credentialing solutions, these issues can be eliminated, keeping both providers and revenue streams flowing.

Why Most Credentialing Services Take 90+ Days

The lengthy credentialing process is often a result of outdated processes, payer bureaucracy, and inefficient verification systems. Fast provider credentialing is crucial in retaining top talent as well. When physicians experience delays, they may feel undervalued and seek opportunities elsewhere. According to NCQA, here’s why credentialing drags on 90+ days:

• Manual paperwork – Many organizations still rely on outdated, paper-based credentialing, leading to delays and errors.
• Slow payer response times – Insurance companies and hospital networks have strict verification processes that require multiple follow-ups.
• Lack of automation – Most credentialing services do not leverage advanced technology to expedite verification and approvals.
• Inefficient provider enrollment – Primary source verification alone is not enough; proper provider enrollment with payers is crucial for timely reimbursements.
• Complex verification requirements – Some payers have lengthy approval processes and may require extensive documentation beyond standard credentialing.
• State-specific regulations – Different states have different requirements, adding additional layers of complexity and potential delay.

Often, the lack of clear communication between healthcare facilities and payers exacerbates credentialing delays. A missing or incorrectly submitted document can halt the entire process, causing unnecessary setbacks. Organizations that fail to track and manage their credentialing tasks efficiently often experience bottlenecks that lead to prolonged wait times for new providers.

For those considering options, fast provider credentialing can streamline the hiring process, enabling practices to attract and retain high-quality providers.

Additionally, staff shortages and high turnover in credentialing departments can further extend the timeline. Credentialing requires attention to detail, but overwhelmed or undertrained teams may struggle to meet application demands, leading to processing delays.

Without a dedicated and experienced credentialing team, healthcare organizations risk prolonged administrative inefficiencies and revenue loss.

How to Get Credentialed in 30 Days (or Less!)

At Fifth Avenue Healthcare Services, we’ve perfected the credentialing process to help healthcare organizations eliminate delays and get providers seeing patients faster. Here’s how we do it:

• Advanced Technology & Automation: We utilize cutting-edge credentialing software to process applications faster and with fewer errors.
• Direct Payer Relationships: Our long-standing relationships with payers and networks help streamline approvals and cut through red tape.
• Dedicated Credentialing Specialists: Our expert team ensures that all necessary documents are submitted correctly on the first attempt, reducing back-and-forth delays.
• Delegated Credentialing: Through delegated credentialing, we have agreements with multiple payers; for providers credentialed through our IPA, we can use one application to enroll a single provider with approximately 25 payers at one time using only one application.
• Proactive Communication: We work closely with healthcare administrators and payers to ensure no bottlenecks in the approval process.
• Real-Time Status Tracking: Our credentialing platform provides administrators with complete visibility into the status of each application, reducing uncertainty.

One of the most effective strategies we implement is a pre-credentialing assessment, where we proactively gather all required documents and verify the accuracy of provider information before the application is submitted. This step helps eliminate errors, missing information, and other common delays that plague traditional credentialing approaches.

By ensuring that all forms and supporting documentation are complete and compliant before submission, we significantly reduce the back-and-forth process that often adds weeks or months to credentialing timelines.

Another critical component of expediting credentialing is our automated follow-up system, which tracks payer responses and flags any application that has not received a timely response. This proactive system lets us immediately reach out to payers and resolve any outstanding issues before they cause significant delays. Instead of waiting for updates from insurance networks or health plans, we take an active role in ensuring progress at every stage of the process.

Real-Life Success Story: One of our healthcare clients needed urgent credentialing for a new provider. Using our streamlined process, we completed credentialing with United in under 17 days, allowing the doctor to start seeing patients and billing immediately.

7 Key Factors For Fast Provider Credentialing

When choosing a credentialing partner, it’s crucial to consider a few key factors. Here’s what you should look for when evaluating potential partners:

1. Speed: How quickly can they credential providers? Look for services that complete credentialing in 30 to 90 days (e.g., Primoris has enrolled a provider in less than 30 days using delegated credentialing in its’ credentialing IPA).
2. Accuracy: Mistakes lead to delays. A reliable partner should have a proven accuracy rate in credentialing applications.
3. Efficiency: Do they handle both primary source verification and provider enrollment? This can help create a more efficient, seamless credentialing experience.
4. Industry Expertise: Credentialing is complex. Choose a company that is NCQA Credentialing Accredited, specializes in healthcare provider credentialing, and works with a vast network of payers.
5. Technology & Innovation: Ensure your credentialing partner uses a credentialing web portal, perhaps automation and AI-powered solutions to accelerate the process and reduce human errors.
6. Regulatory Compliance: A trusted credentialing partner will have a deep understanding of CMS, NCQA-Credentialing Accreditation, and team members with certification and expertise in other industry regulations to ensure compliance at all levels.
7. Customer Support & Transparency: Your partner should provide ongoing support, clear communication, and real-time tracking of applications.

Common Credentialing Myths and Misconceptions

Some healthcare administrators hesitate to outsource credentialing due to common myths. Let’s debunk a few:

• “Credentialing must always take 90+ days.” – Not true! With the right team, streamlined credentialing processes, and technology, many providers can receive enrollment in 30 days or less.
• “Credentialing is just filling out forms.” – No, credentialing is a complex process, traditionally with a minimum of 52 conventional steps requiring verification, payer communication, and regulatory compliance.
• “In-house credentialing is always more cost-effective.” – In reality, outsourcing often reduces costs by eliminating inefficiencies and delays. Notably, research from NAMSS reveals that credentialing through a CVO is five days faster than specialty hospitals and seven days faster than acute hospitals in average file verification turnaround time (source: NAMSS Medical Service Staffing Study, September 2009).
• “All credentialing services are the same.” – Not all credentialing companies offer fast, tech-enabled, and payer-integrated solutions like we do at Fifth Avenue Healthcare Services. Fifth Avenue Healthcare Services is one of a few CVOs with NCQA-CR Accreditation. Primoris is one of the only true credentialing IPAs in the country offering delegated credentialing for provider enrollment in 25+ payers using a single application.
• “Once credentialed, a provider is good to go forever.” – Not true. Re-credentialing and ongoing monitoring are required to maintain compliance and avoid disruptions.

Another common misconception is that credentialing is a one-size-fits-all process. In reality, different healthcare organizations have unique payer relationships, provider specialties, and regulatory requirements that can influence the complexity of credentialing.

A high-quality credentialing service considers these nuances, offering customized solutions that address each provider’s and practice’s specific needs. Working with an experienced credentialing partner ensures your organization can navigate these complexities efficiently and effectively.

Conclusion: The Hidden Cost of Slow Credentialing

Credentialing is a vital process that directly impacts a healthcare organization’s efficiency, revenue, and ability to provide quality patient care. Delays in credentialing result in financial losses, strain administrative resources, create provider frustration, and compromise patient access to timely care. By implementing a streamlined credentialing strategy, healthcare organizations can eliminate these inefficiencies and ensure that providers are ready to practice as soon as possible.

Choosing the right credentialing partner reduces processing times and improves overall operational effectiveness. Organizations that leverage technology, proactive communication, and established payer relationships will benefit from a seamless and expedited credentialing process. Fifth Avenue Healthcare Services is committed to providing a solution that simplifies credentialing and ensures providers are ready to deliver care quickly and without unnecessary hurdles.

If your organization is experiencing credentialing delays, a fast provider credentialing approach is what you need now. A faster, more reliable credentialing process not only saves time and money but also enhances patient satisfaction and improves provider retention.

Take Action: Let’s Get Your Providers Credentialed Faster

Every day your providers aren’t credentialed is a day of lost revenue and missed patient care opportunities. Why wait 90 to 180 days when you can get credentialed in 30 days or less?

Contact us today to see how we can streamline your credentialing process and get your providers seeing patients—FAST.

Visit PrimorisCredentialingNetwork.com and reach out today!

More information about Primoris Credentialing Network

Primoris Credentialing Network is NCQA Credentialing Accredited, specializing in credentialing and provider enrollment with 54+ health plan and network provider enrollment options. Primoris is a family member of Fifth Avenue Healthcare Services. Sister companies include 5ACVO (credentialing and primary source verification specialists) and Fifth Avenue Agency (MPLI and medical malpractice specialists).

This article was originally published by Primoris here. For more information, please visit Primoris or Contact Us.

Fast provider credentialing can significantly influence your bottom line by reducing the time it takes for providers to get to work, thus accelerating revenue generation.

In conclusion, embracing fast provider credentialing is essential for any healthcare organization aiming for operational excellence and high-quality patient care.

Contact us today to discuss how our fast provider credentialing solutions can be tailored to meet your organization’s needs.