How long does credentialing take? Who controls each step, and why I won't quote you a date
By Kay Ward, founder of Lanyard Health
Short answer: for most insurance payers, credentialing and enrolling a new provider takes four to six months from the day the application goes in, and the payer's own review takes up most of that time. After approval, plan on about 30 more days of payment setup before money arrives. Medicare, Medicaid and each commercial plan run on their own clocks.
On the first call, practice owners ask me when their provider will be approved. I don't give a date, and I'd rather explain why than make one up. You'll see shorter numbers online (90 to 120 days shows up a lot). Before you plan around any number, ask what it counts from and what it counts to.
Credentialing vs. payer enrollment
Credentialing verifies a provider's education, licenses and work history. Payer enrollment is the application to join an insurance company's network so you can bill it as in-network. Most practices say "credentialing" for both, and the timeline you care about covers both.
Who controls each step of the credentialing timeline
A credentialing timeline has more than one owner. The payer holds the biggest share of it, and your practice holds more of it than you'd expect. Anyone who hands you an exact approval date is promising something on the payer's behalf.
Step | Who controls it | What a stall looks like |
|---|---|---|
Getting a complete, correct application together | The credentialing company | Missing documents, an old address, a CAQH profile that doesn't match the application |
Signatures and attestations | Your practice | An application sitting unsigned in someone's inbox |
Keeping CAQH ProView attested and current | Your practice (we remind you) | The payer pulls CAQH, finds it expired, and pauses the review |
When the application goes in and how often someone follows up | The credentialing company | Weeks go by with nobody calling the payer |
Answering the payer's questions | Your practice and the credentialing company together | A request for one more document goes unanswered |
How long review takes | The payer | Four to six months for most payers |
Whether they say yes | The payer | A denial, or a panel that's closed to new providers |
Your effective date | The payer | An effective date later than the day your provider started seeing patients |
Contract terms and rates | The payer | Rates you can't change without negotiating |
Why is my credentialing taking so long?
Start by finding out who the file is waiting on. A lot of the stalls I see start on the practice side, and they're easy to fix once somebody spots them. An application sits waiting for the provider's signature, or a CAQH profile lapses because nobody reattested (the payer pulls CAQH during review and stops when it finds it expired). The payer won't call to tell you it's waiting on you.
If the file is with the payer, the review length, the yes or no, the effective date and the contract all sit with them. A clean application keeps it from bouncing back, but nobody outside the payer decides how fast a reviewer gets to your file. Some payers also close their panels in a specialty or area, and then they won't take new providers at all.
What the credentialing company controls
We control whether the application goes in complete and correct, when it goes in, how often we chase it, and whether you know where it stands. A person reads every application before it goes out and calls the payer when something stalls. The software pulls provider details from CAQH, collects documents and tracks every enrollment's status.
Why I won't quote an approval date
The payer owns that clock, so any date I gave you would be a guess. For every provider and every payer, you see what's still waiting and who it's waiting on. If it's waiting on you, you'll hear about it that week. If it's waiting on the payer, we keep calling.
Questions practices ask me
Can credentialing be sped up?
The practice side can. Keep every provider's CAQH attested, and sign or answer anything from the payer the day it lands. That covers most of the stalls I see on the practice side. The payer's review runs at the payer's pace.
Some companies promise credentialing in a few days. Are they wrong?
Read what the number measures. A lot of the fast numbers on sales pages measure file readiness, the day the application is ready to send. The credentialing company controls that part. The payer's review comes after it.
Does it take the same time for Medicare, Medicaid and commercial insurance?
No. Each program and each commercial plan runs its own review, and Medicaid timing changes from state to state. Plan each payer on its own timeline.
Does the clock stop at approval?
No. After approval you still need about 30 days of payment setup before money moves. I wrote about that part here: Approved isn't paid.