Credentialing in healthcare is a mandatory but time-consuming process for providers, payers, and health systems alike. It’s fraught with extensive paperwork, multiple background checks, and compliance reviews, which can delay start dates and onboarding timelines. Yet, provider credentialing plays an essential role in ensuring patient safety and maintaining clinical excellence.
If you’re preparing to onboard a healthcare professional or begin a new role yourself, understanding how long credentialing takes is crucial. This article breaks down the typical timeline, highlighting factors that influence its duration and how to accelerate the process and start patient care faster.
Typical Credentialing Timelines
The credentialing process is tedious, as it involves gathering and verifying different documents across educational institutions, state licensing boards, and professional organizations. Providers must also complete different types of credentialing, including initial credentialing and periodic recredentialing, to stay compliant and demonstrate continued competence.
On average, credentialing can take anywhere from 60 to 180 days, depending on factors like the complexity of the provider’s qualifications, the organization type, and specific payer requirements. Initial credentialing typically lasts between three to six months, involving preparation (two to four weeks), application review (60–120 days), and final enrollment (two to four weeks).
Recredentialing, which occurs every two to three years, is often shorter. It typically takes between two to four months to complete, broken down into preparation (four to six weeks) and payer review phases (30 to 90 days).
However, credentialing timelines vary by organization type, as hospitals usually take 60 to 120 days, payers take 90 to 120 days, telehealth companies range from 15 to 45 days, Medicare takes 60 to 90 days, and Medicaid falls between 45 to 90 days.
Understanding these timelines can help healthcare professionals and recruiters plan better to avoid costly delays that prolong onboarding.
Factors That Affect Credentialing Duration
Below, we explore the factors that determine how long the credentialing process takes:
Provider Response Time and Document Accuracy
Delays in provider response and inaccuracies in submitted documents are common reasons credentialing takes longer than expected.
Missing or inaccurate provider information often leads to repeated follow-ups and requests for additional documentation, which can extend the timeline by weeks or even months, especially when there’s no efficient system for requesting or verifying details.
Furthermore, delayed submissions from providers make matters worse. To avoid these setbacks, it’s crucial to verify all provider information for accuracy and encourage timely submission of all required documents.
Third-Party Verification Delays
When credentialing bodies receive a high volume of applications, the review timeline often extends, as staff must thoroughly review each provider’s licenses, certifications, education, and work experience.
Additionally, external organizations, such as educational institutions, previous employers, or licensing boards, may be slow to respond to information requests, further slowing down the approval process. Similarly, outdated evaluation workflows or processing errors from credentialing teams can also prolong the timeline, ultimately affecting provider start dates and delaying patients’ access to care.
State and Payer Variability
Credentialing requirements and timelines vary significantly between states, payers, provider types, and healthcare facilities. Each entity has its unique specifications that can prolong verification.
For example, in Texas, processing times fall within 180 days, as physicians must submit a completed Texas Standardized Credentialing Application, undergo qualification checks, and possibly an on-site visit to their facility by the HMO’s credentialing committee.
Similarly, insurance payers like Medicare and Medicaid also have their own documentation and approval procedures. These variations mean that a provider credentialed in a particular jurisdiction or insurance network may still encounter delays when moving to another state or payer.
How to Speed Up the Credentialing Process
Although credentialing can be time-consuming, there are effective ways to accelerate the process and avoid costly delays, sometimes saving weeks or even months.
Strategies, such as using credentialing software, standardizing your onboarding procedures, and outsourcing to credentialing specialists, can significantly reduce the time it takes to verify a provider’s professional standing. Here’s how:
Use Credentialing Software
Credentialing software helps speed up the process by automating repetitive tasks, such as collecting documents, sending submission reminders to providers, and tracking license expiration dates.
It centralizes provider information in one secure platform, reducing manual errors and making it easier for teams to collaborate. Many tools also include automated recredentialing alerts and built-in compliance checks to continuously monitor provider credentials. This efficiency reduces the administrative burden on credentialing teams, freeing up time for more strategic initiatives.
Standardize Your Onboarding Procedures
Defining your onboarding process ensures every healthcare provider follows a consistent path from hiring to credentialing and privileging. It also reduces errors and omissions, maintaining accuracy and compliance during credentialing.
Start by developing step-by-step guidelines or workflows for credentialing teams to follow from application submission to approval. These guidelines should outline required documents, expected timelines, communication protocols, and responsibilities for each stage. Additionally, include a checklist that specifies submission deadlines, key milestones, and follow-up dates to monitor progress and avoid unnecessary delays during onboarding.
Here’s a sample checklist for a new healthcare provider:
- Complete the credentialing application.
- Submit a government-issued photo ID, such as a driver’s licence or passport.
- Provide your Social Security Number or Tax ID.
- Submit your educational qualifications (medical school diploma, Continuing Medical Education (CME) certificate (if applicable), residency, or fellowship certificates).
- Include all licences and certifications (state medical license, DEA certificate, CPR/ACLS/BLS certification, or board certification (if applicable).
- List complete work history for the past five to ten years, explaining any employment gaps.
- Add references from previous employers or supervisors.
- Disclose any disciplinary actions, sanctions, or legal issues.
- Submit supporting documents (NPI number, Medicare/Medicaid enrollment, and signed consent forms).
Hire Dedicated Credentialing Teams or Partners
Healthcare Provider Credentialing Solutions specialize in handling the credentialing process with expertise. They have established relationships with payers and can follow up when due to ensure a smooth process. They also stay up-to-date with evolving employment regulations, and unlike in-house staff, they focus solely on credentialing, relieving the burden on your internal team.
However, potential drawbacks, such as miscommunication and reduced control over the process, can affect outcomes. To avoid this, healthcare organizations must balance the need for external support with internal coordination by maintaining clear communication and defined responsibilities.
Avoiding Common Delays with Credentialing
To further prevent delays during credentialing, ensure all provider documentation, including certifications, licenses, and CVs, is accurate and up-to-date. Clearly communicate each required step and document to providers, and set up automated reminders for follow-ups whenever additional actions are needed.
Additionally, regularly conduct credentialing audits to identify and fix costly credentialing issues, such as data inaccuracies, poor communication, missing files, and outdated licenses. When not addressed, these issues often result in compliance penalties, including hefty fines, reputational damage, and the suspension of a provider’s billing privileges.
Speed up Credentialing Timelines with Verisys
Provider credentialing is an essential but time-consuming process, typically taking 60 to 180 days to complete. While timelines vary depending on provider type, payer, and location, healthcare organizations can reduce delays by cross-checking all documents for accuracy, submitting applications early, scheduling follow-up reminders, and adopting credentialing software.
Implementing these strategies doesn’t have to be overwhelming. Verisys simplifies the process, offering automated tools, industry expertise, and real-time data verification. Whether you’re managing credentialing in-house or outsourcing it entirely, Verisys helps accelerate provider onboarding, allowing your team to focus more on patient care and less on paperwork.
Sources:
National Credentialing, How long does credentialing take.
https://nationalcredentialing.com/how-long-does-credentialing-take/
TDI Texas, What are the HMO credentialing requirements?
https://www.tdi.texas.gov/hmo/providercredreq.html.
Medicare, Medicare Credentialing Made Easy: A Step-by-Step Guide for Therapists.
