It usually starts with a message no healthcare executive wants to see:
“We can’t move this provider through credentialing until we verify their sanctions history again.”
With this, entire departments can come to a standstill. What looked like a routine provider onboarding suddenly exposes deeper issues, like:
- Data gaps
- Inconsistent workflows
- Limited visibility
- Delays caused by manual, back-and-forth communication
Credentialing is no longer just an administrative function; it’s a core driver of operational stability. Yet without the right metrics, it’s difficult to understand where processes are breaking down.
Ultimately, credentialing has become too important, too regulated, and too interconnected with the rest of the organization to operate without clear insight. Today, healthcare executives need clear, actionable credentialing metrics that reveal where processes can be strengthened.
What Are Credentialing KPIs?
Credentialing metrics, or key performance indicators (KPIs), show how effectively a healthcare organization is verifying, onboarding, and monitoring its providers. They translate a highly complex and regulated process into clear signals, helping leaders understand whether or not credentialing is running smoothly.
At their core, these KPIs answer three critical questions:
- Are we compliant?
- Are we efficient?
- Are we protecting our organization from avoidable risks and exposures?
In healthcare, regulatory expectations evolve rapidly, and outdated data can lead to severe operational and financial consequences. Here, KPIs offer a consistent way to evaluate performance, and they’re used across the organization by:
- Executives who need a clear view of operational stability and enterprise risk
- Credentialing managers, who oversee daily workflows and provider file movement
- Compliance teams, who rely on accurate, current data to meet regulatory standards.
- Network and provider operations leaders, who depend on timely onboarding to maintain adequate access to care
When these teams track the right KPIs, credentialing moves from a reactive function to a strategic asset.
Key Credentialing KPIs to Monitor
To understand where credentialing succeeds and where it stalls, a few core KPIs offer the clearest visibility.
Average Credentialing Turnaround Time
This metric tracks the total elapsed time from when a provider’s credentialing application is submitted to when they are fully approved and eligible to start seeing patients or bill payers. It’s a litmus test for process efficiency and a window into workflow bottlenecks.
The longer the credentialing timelines extend, the greater the operational and financial risk. Put another way, delayed provider access often leads to lost revenue and increased administrative overhead. It also signals where the credentialing process is breaking down: whether documentation is missing, verifications are slow, or internal hand-offs are inefficient.
So, how do you measure and optimize for this KPI?
- Track average days to credential (and re-credential) by provider type, state, and payer.
- Benchmark against internal targets (for example, initial credentialing should take less than 90 days, and re-credentialing should take less than 60 days).
- Introduce dashboards that show live pipeline status (e.g., number of files in “awaiting primary source verification,” “awaiting payer enrollment,” etc.).
- Consider automation and verified data feeds to reduce delays at the verification and application stages.
Provider Data Accuracy Rate
Consider a hospital system preparing for a routine audit. Leadership assumes the provider directory is current until a review reveals that 35% of specialist profiles contain outdated information, including incorrect phone numbers, expired licenses, or providers who are no longer practicing. In one instance, a patient referral was routed to a retired physician, forcing a two-week reschedule and triggering an internal investigation.
This is precisely why the provider data accuracy rate is important. This KPI reflects how complete and current your provider records are, ultimately answering a fundamental question: Can your organization trust the provider data it relies on every day?
To measure and optimize for this KPI:
- Set a target accuracy rate (for example, 95% of all provider records must be verified as up-to-date within the last 90 days).
- Audit a random sample of provider records monthly for completeness (license status, sanctions, affiliations, contact details).
- Track “error-rates” or “data change-frequency” (for example, how many records require updates each month).
- Implement source-of-truth verification tools (license databases, sanction lists, credentialing registries).
Recredentialing Completion Rate
This KPI tracks the percentage of providers whose re-credentialing processes (renewal of credentials, sanctions checks, licensing updates, and privileging) are completed before their current credentials expire.
To measure and optimize this metric effectively:
- Track the number of providers whose re-credentialing is fully processed before expiry and divide that by the total number of providers due for re-credentialing, multiplied by 100.
- Segment by provider type (physician, advanced practice, allied health), specialty, and location to spot weaker areas.
- Set internal alert thresholds. For example, if the anticipated completion rate drops below 90% for any segment, trigger a review.
- Build automated renewal reminders, centralized tracking of upcoming expirations, and real-time dashboards.
Application Error Rate
This KPI measures the percentage of credentialing applications that contain errors or omissions, such as missing documentation or incomplete fields. This matters because:
- Every error in an application creates wasted time: Providers must submit missing information, verifiers must re-check files, and committees must revisit incomplete files. These delays compound across workflows.
- A high error rate indicates training gaps, system issues, or design faults in the process.
- In the context of compliance, incomplete or incorrect provider credentialing may result in inaccurate records, which can impact audits and accreditation.
Leaders can tackle this KPI by:
- Tracking the following: (Number of credentialing applications submitted with one or more errors), divided by (Total number of applications submitted), multiplied by 100.
- Breaking down errors by type (missing docs, snags in data entry, non-compliance) and by source (provider vs. staff vs. system).
- Setting target thresholds (for example, an error rate of less than 5%). Monitor upward trends and intervene early.
Time to Primary Source Verification (PSV)
This KPI tracks the elapsed time from when the credentialing team initiates the primary source verification (PSV) of a license, certification, training, or other credential, to when the verification is complete and logged. Essentially, it asks: How fast (and how reliably) are you verifying provider credentials from the sources?
Leaders can optimize for this metric through:
- Tracking the date when PSV was initiated to when it is completed. They may also calculate the average days and monitor the distribution (such as the median and the 90th percentile).
- Segment by credential type (license, certification, training), provider origin (domestic/international), and source type (state board, educational institution).
- Set target benchmarks (for example, PSV completed within 14 business days for domestic, 30 days for international).
- Identify bottlenecks by source and provider category; build escalations for slow responses.
Best Practices for Optimizing Credentialing KPIs
Despite challenges, it is possible to improve credentialing metrics. All you need is clarity, consistency, and the right infrastructure to support high-quality data.
- Automate – Automation reduces manual effort, minimizes errors, and accelerates verification steps. When teams aren’t stuck chasing documents or re-entering data, they can focus on higher-value work.
- Review – Establishing monthly or quarterly review cycles helps teams identify trends early, such as rising turnaround times, seasonal workload spikes, or recurring data accuracy issues. More importantly, reviews help leaders understand where improvements are most urgent.
- Collaborate across departments – When HR, compliance, medical staff, and network operations teams operate in silos, the process slows. Regular cross-functional check-ins, shared dashboards, and unified definitions of each KPI can ensure that everyone is working toward the same goals.
Turning Metrics Into Measurable Improvement
Credentialing will always carry a certain level of complexity, but it shouldn’t leave leaders guessing. When organizations track the right KPIs, patterns become clearer: where files get stuck, why timelines stretch, and which parts of the process introduce the most risk.
As scrutiny around provider data grows and workloads continue to rise, the organizations that succeed will leverage credentialing solutions built on accurate, centralized, and continuously monitored data.
This is exactly where Verisys can help. With data-driven healthcare provider verification solutions and healthcare exclusion screening services, Verisys provides healthcare leaders with the insight they need to reduce administrative burdens.
Your current process may feel more reactive than reliable. However, with the right KPIs (and the right data foundation), you can build a healthcare license verification and credentialing operation you trust.
Sources:
MDPI. A Systematic Review on Professional Regulation and Credentialing of Public Health Workforce. https://www.mdpi.com/1660-4601/20/5/4101
ResearchGate. Hospital readiness in implementing credentials, verification and readiness of medical personnel according to Staff Qualification and Education (SQE) assessment element 10 accreditation standards in Regional General Hospitals of West Muna District Southeas. https://www.researchgate.net/publication/375306645_Hospital_readiness_in_implementing_credentials_verification_and_readiness_of_medical_personnel_according_to_Staff_Qualification_and_Education_SQE_assessment_element_10_accreditation_standards_in_Regio
McKinsey & Company. Principles for provider investments in 2025. https://www.mckinsey.com/industries/healthcare/our-insights/healthcare-blog/principles-for-provider-investments-in-2025
McKinsey & Company. How to attract and retain physicians in a challenging labor market. https://www.mckinsey.com/industries/healthcare/our-insights/healthcare-blog/how-to-attract-and-retain-physicians-in-a-challenging-labor-market
