Common Credentialing Challenges and How to Overcome Them

 

Credentialing is a critical process for healthcare providers to join payer networks, but it’s rarely straightforward. With paperwork, deadlines, and payer-specific requirements to navigate, even small mistakes can lead to significant delays. In this blog, we’ll explore some of the most common credentialing challenges providers face, and how to overcome them for a smoother, more efficient process.

Challenge 1: Incomplete or Incorrect Applications

Many credentialing delays stem from missing or inaccurate information in the application. Providers often overlook details like:

• Incorrect NPI numbers.

• Missing malpractice insurance documentation.

• Failing to complete sections that don’t apply (e.g., not checking "N/A").

Solution:

• Double-Check Before Submission: Create a credentialing checklist to ensure all required fields and documents are complete.

• Use Credentialing Software: Platforms like Availity or CAQH automatically flag incomplete sections, reducing errors.

• Partner With Experts: Credentialing coordinators like P.S. Practice Solutions can handle applications from start to finish.

Challenge 2: Poor Communication With Payers

Once an application is submitted, payers may reach out with requests for additional information or clarification. Missing these communications can cause major delays.

Solution:

• Designate a Point of Contact (POC): Ensure a single person, such as a credentialing coordinator, is responsible for monitoring payer updates.

• Secure Portals: Use payer portals to track credentialing status and respond promptly to requests.

• Regular Follow-Ups: Don’t wait for payers to contact you. Set reminders to follow up every 7–14 days.

Challenge 3: Understanding Payer-Specific Requirements

Every insurance payer has unique credentialing criteria, timelines, and processes. Without payer-specific knowledge, providers risk submitting incomplete or non-compliant applications.

Solution:

• Research Payer Guidelines: Review credentialing instructions on payer websites or through provider support contacts.

• Maintain a Payer Directory: Keep a database of payer requirements for your practice to streamline future applications.

• Stay Updated: Insurance regulations and requirements change frequently. Subscribe to payer newsletters or updates.

Challenge 4: Delays in Recredentialing

Credentialing doesn’t end once you’re approved. Providers must go through re-credentialing every 2–3 years to stay in-network. Missing re-credentialing deadlines can result in suspension from payer networks.

Solution:

• Track Expiration Dates: A credentialing tracker monitors license, malpractice insurance, and payer approval expiration dates.

• Automate Reminders: Set up alerts for deadlines 90, 60, and 30 days in advance to ensure timely re-credentialing.

• Plan Ahead: Begin re-credentialing at least 120 days before the expiration date.

Challenge 5: High Workload and Lack of Resources

Credentialing can be time-consuming, especially for small practices without dedicated staff. Balancing credentialing with patient care and other administrative tasks often leads to errors or delays.

Solution:

• Outsource Credentialing: Partner with a credentialing expert or service like P.S. Practice Solutions to handle the workload.

• Batch Applications: Submit multiple applications for group practices simultaneously to save time.

• Leverage Technology: Invest in credentialing software to automate and track processes.

Bonus Tip: Preventing Denials Related to Credentialing

Even with credentialing completed, errors can occur that impact claims. For example:

• Submitting claims before credentialing is finalized.

• Please update your NPI or tax ID with payers after changes.

How to Avoid These Issues:

• Confirm enrollment is active before submitting claims.

• Regularly update payer records with any changes to your practice information.

Conclusion

Credentialing challenges are common, but they don’t have to disrupt your practice. Understanding common roadblocks and taking proactive steps to address them can streamline the credentialing process and minimize delays.

If credentialing feels overwhelming, remember you don’t have to do it alone. At P.S. Practice Solutions, we specialize in navigating the complexities of credentialing so you can focus on delivering excellent patient care.

Ready to simplify credentialing for your practice? Visit P.S. Practice Solutions or schedule a free consultation today. Let’s tackle these challenges together!