Critical Reasons to Partner with a Medical Credentialing Company

One of the most important but little-known parts of running a healthcare business is medical licensing. Credentialing is a way for insurance companies to verify that you are qualified. They make sure you’re real and qualified before they pay a single claim. If you don’t have credentials, you can’t bill insurance. Claims are rejected when the right credentials are not shown. Delays in reimbursement can last for weeks or even months. Your practice is losing money like a sieve. 

But most practitioners and practice managers have never overseen an application for credentials. There are a lot of legal requirements, differences across payers, and tight deadlines in this process. Approval takes 30 to 60 days longer if one paper is missing. A password that isn’t written correctly, or an outdated reference, sets you back even more. This is exactly why it has become normal for high-performing healthcare organizations to work with a certification business. 

It’s not a question of whether credentials are important. It does, for sure. The real question is whether your business has the skills and time to handle it well or whether you should hire a specialized company to do it for you. 

7 Critical Reasons to Partner with a Medical Credentialing Company 

Here are some important reasons why you should work with a medical licensing business to improve the reputation of your practice.  

Reason 1: Credentialing Companies Eliminate Timeline Delays 

Insurance credentials are slowing things down. Most payers take between 60 and 90 days to process an application for credentials. Some take longer if the paperwork isn’t complete or if they have a lot of work to do. 

This is where most practices fail: they send in forms that aren’t complete. A request for more information is made when there isn’t a reference letter, an up-to-date record, or a full-time job background. Your money is sent back to you. You are rushing to get paperwork. The timeline is over. The process that should have taken 60 days takes 120 days or more. 

Credentialing companies keep standard filing methods and stay in touch with relationship managers at big payers. They know which papers each client needs, how to send them, and by when they need to be sent. The first time they send an application, it is complete. When payers ask for more information, credentialing companies respond right away instead of waiting for their own teams to find the data. 

Timeline comparison

Self-managed with little or no paperwork: 120 to 180 days 

Fully documented and self-managed: 60 to 90 days 

Submission from a credentialing company: 50 to 75 days (for the first acceptance) 

Each month that a new business has to wait for credentials is a month that they lose money. Plan to make $50,000 a month once all your credentials are in order. You lose $100,000 in unrealized income every 60 days. The money spent on the credentialing business pays for itself in the first month of delays. 

Reason 2: They Manage Payer-Specific Variations and Requirements 

Not every insurance company needs the same information in the same way. Commercial companies and Medicare have different ways of getting credentials. Blue Cross and UnitedHealth have different standards. Each provider has its own application form, list of documents that must be sent, and way to verify the information. 

To handle these differences internally, you need someone on your team to know the specific needs of 15, 20, or even 30 or more customers at the same time. As payers change how they do things, that person needs to keep training. They need to know how to get in touch with payers, what to do when applications get stuck, and how to leverage relationships to speed up requests. 

This is not something that most groups are good at. The person in charge of billing or running your business already has a lot to do without having to learn about credentials as well. Credentialing companies invest heavily in building connections with payers and learning about the process because their main job is to deal with differences across dozens of payers. 

They maintain

Current standards for credentials for more than 100 users 

Direct lines of communication with payment authorization offices 

Automated tracking tools that indicate when applications are getting close to due dates for responses 

Escalation methods to speed up apps that are stuck 

Keep messages up to date when payers change how they do things. 

Your licensing company quickly updates its forms when a payer changes the way they want things to be submitted in the middle of the year. This doesn’t have to be tracked by your business on its own. 

Reason 3: Credentialing Companies Reduce Billing Errors and Denials 

Claims are directly rejected when identification of information is incorrect. If a payer has the wrong NPI on file for you, claims filed under that NPI will be denied. In your provider agreement, do you have the wrong tax ID or office address? They might not be able to handle your cases. Outdated or wrong information about malpractice insurance? Your credentials are taken away. 

Credentialing mistakes also pose a risk to safety. If a provider checks your credentials but doesn’t believe them and you still send claims, you could be sued, have your contract terminated, or be investigated for compliance. 

Credentialing firms check all the information you give them before you send it in. They keep an eye on your live passwords to make sure the information is always correct. They let you know when it’s time to renew your legal insurance, when your licenses need to be updated, or when your payer contracts need to be renegotiated. 

This mistake prevents claim rejections and payment issues that cause hundreds of hours of extra work. It takes a practice manager weeks to find licensing mistakes while looking into why 10% of claims are being rejected. A certification company would have caught them when they were set up the first time. 

Reason 4: They Handle Maintenance and Ongoing Compliance 

After the first acceptance, credentialing doesn’t end. You have to keep your credentials up to date, let payers know when your information changes, and re-credential every so often as payers change their standards. 

Your licensing status changes when you refresh your license, update your DEA registration, finish continuing education, change your legal insurance, or add or remove jobs. If you miss the time to refresh your credentials, they will expire, and you won’t be able to submit a claim. 

A lot of companies don’t have a set way to keep track of these events. One date is when your license is renewed. Use your DEA number on another. Insurance for malpractice is yet another. If you miss one update, the whole chain of credentials breaks. 

Credentialing companies keep track of all events automatically. They tell people to renew their licenses before the due dates and to make sure all changes are complete. They work with your insurance companies and licensing boards to make sure you stay in line. 

This ongoing management keeps practices from having to deal with the problem of finding out in the middle of the year that a provider’s license or DEA registration has ended, which requires immediate action and short delays in handling claims. 

Reason 5: Credentialing Companies Free Up Internal Staff for Patient Care 

Most businesses don’t realize how much it costs to hire people to manage credentials internally. A person on staff who is in charge of licensing applications spends 10 to 20 hours a week gathering paperwork, filling out forms, following up with payers, and resolving issues. 

That’s half of a full-time worker’s week spent on licensing tasks instead of tasks that bring in revenue or support patient care. When a practice doesn’t have enough staff, important schedule and payment problems can push licensing to the back burner, causing delays and unfinished work. 

When you outsource credentialing, your team is free to focus on front-office tasks that directly help patients and generate income, like scheduling appointments, verifying insurance, processing payments, and supporting clinical operations. 

Cost comparison

Internal credentialing staff: 0.5 FTE at $25/hour = $26K annually, plus benefits ($8K-10K) 

Total internal cost: $34K to $36K annually 

Outsourced credentialing: $150 to $300 per provider per month, or 2 to 4% of collections 

For a practice credentialing 5 providers: $1,500 to $3,000 monthly, or $18K to $36K annually 

The cost is comparable, but the quality is higher. A credentialing company specializes in this work. Your staff returns to patient-facing roles. 

Reason 6: They Provide Scalability for Growing Practices 

Every client needs to go through a full licensing loop with each new provider. When you add two providers per year, the licensing workload doubles. For this kind of work, it doesn’t make much sense to hire more people. 

Outsourced identification grows without adding more staff. A company that controls credentials can handle 50 new providers a year just as well as 5. Your practice makes more money and makes things more complicated without making things harder to manage. 

Scalability includes growth in more than one place as well. To open a second location, you need to re-credential with all customers at the new address, keep the building information up to date, and ensure that all location-specific rules are followed. A certification business makes sure that all payers are coordinated methodically at the same time. 

Reason 7: Credentialing Companies Provide Expert Compliance and Audit Support 

As your business grows and more providers are added, licensing work will also grow. Insurance verification is more than just a paperwork job. To follow state licensing laws, federal healthcare rules, and client contracts, you must do this. Credentialing mistakes can lead to compliance checks, contract termination, or getting back money for claims. 

Credentialing businesses stay up to date on changes to regulations and safety standards. They check your service files to make sure that all the paperwork meets state and federal standards. They get you ready for customer checks by putting your files in order and making sure all of your paperwork is correct and complete. 

A lot of practices don’t find problems with credentials until they are audited. A certification company finds problems and fixes them before they happen. 

The Financial Reality: Outsourcing Credentialing Protects Revenue 

Consider a practice with 5 active providers. Here’s the financial impact of credentialing problems: 

This isn’t theoretical. Every year, these exact problems happen to practices that don’t handle credentials well. The cost of outsourcing is nothing compared to the damage that bad credentials do. 

What to Look for in a Credentialing Company Partner 

It’s not always the case that credentialing companies are the best. When judging partners, make sure you: 

Credex Healthcare offers authentication, assistance with medical bills, and smart security features. That cuts down on the number of companies your office has to handle while keeping provider information consistent across all services. 

Frequently Asked Questions: Medical Credentialing Company Partnerships 

How quickly can a credentialing company get you credentialed? 

The average time for the business as a whole is 60 to 90 days, but most credentialing companies aim for 50 to 75 days from application to initial acceptance. The actual timeline relies on how busy the payer is, how full your paperwork is, and whether you have a history with that payer. 

What information do you need to provide to a credentialing company? 

They will ask for your most recent resume, papers from medical school, information about your internship, your current license and DEA registration numbers, information about your accident insurance, references from past jobs, and information about where you do professional work. They take care of everything else. 

Can a credentialing company guarantee approval? 

Payers make the final choices, so no certification company can promise acceptance. But a trustworthy business promises full and correct entries that increase the chances of approval on the first try. 

What happens if your application is denied? 

A credentialing company looks into the reason for the rejection and resubmits with the right information. After getting a license from the state, denials are rare, but they can occur if paperwork is missing or out of date. A credentialing firm makes sure that resubmissions are quick and complete. 

Do you still need a credentialing company if you’re credentialed with a payer already? 

Yes. Established providers get ongoing help with maintaining their credentials, keeping an eye out for chances to renegotiate their contracts, and getting help when they open new sites or specialize in new areas. Credentialing companies improve current profiles of providers to cut down on rejections and increase payments. 

Can a credentialing company help with recredentialing? 

Yes. When you need to renew your credentials, which usually happens every 3 years, you must resubmit and verify all your paperwork. Credentialing companies take care of the entire process. 

Final Thoughts 

When you choose to work with a licensing company, you’re protecting your practice’s income and ability to stay in compliance. The cost is very small compared to the money lost because of poor credentials. Most healthcare businesses that do well hire experts to handle licensing and spend their own resources on caring for patients and growing the business.