How Healthcare Providers Can Join Insurance Networks Faster

Manual credentialing for providers to join an insurance network can be a long and drawn-out process. Physicians, specialists, and clinics looking to increase their patient volume and create a stable revenue source can do so by joining insurance networks. However, this can take months as many are left without income and have become very frustrated.  

Many healthcare organizations experience delays when attempting to join an insurance network due to a lack of knowledge of the insurance credentialing process and other barriers. To expedite the process of joining an insurance network, many providers find success by working with professional medical credentialing services that handle application management, verification, and follow-up on all required documentation. 

In this blog, we will explain how healthcare providers can join insurance networks faster, with a focus on insurance network enrollment, provider enrollment services, the CAQH enrollment process, and the insurance credentialing process, so one can arrive at an informed decision.  

Understanding the Insurance Credentialing Process 

Insurance credentialing, also referred to as provider enrollment, is the formal process by which payers validate the credentials of a provider prior to adding them to their network. For a physician, specialist, clinic, and new practice, the steps in the process include:  

• Verifying active medical license and DEA number  

• Verifying education, training and board certifications  

• Verifying malpractice history and insurance coverage  

• Verifying professional reference and any disclosable events  

Following completion of the validation process, the application will be routed to a credentialing committee. Once approved by the committee, you would sign a contract and formally become an enrolled provider.  

The time frame from the initiation of the credentialing process to signing the contract can be approximately 90 to 120 days. However, some payers and specialties may require up to 180 days or longer to complete the process, depending on the timeliness of submission of all required information and documentation. This time frame is typically inconsistent with the typical time frames for launching a new provider. Therefore, many practices seek to join multiple insurance networks as quickly as possible, either through streamlined workflows or by outsourcing medical credentialing services. 

Common Challenges Providers Face 

Regardless of their experience as healthcare providers, there are a number of common problems that can delay enrollment in an insurance network. 

Inconsistencies in documentation 

Although they may seem like minor, small inconsistencies such as missing W-2s, incomplete or unverifiable affiliations, etc., can result in multiple corrections that may extend enrollment by several weeks. In addition, many offices will provide slightly different information for each payer, which increases the potential for errors and manual review. 

Slow primary‑source verification 

Primary-source verification is required by payers to verify a provider’s licensure, certification, education, and training with the relevant primary sources, such as boards, hospitals, and universities. Unfortunately, if the provider’s past institutions have delayed responding or do not respond at all to the payer’s request, the time for verification can range from 4 to 6 weeks to more than 3 months. 

Payer backlogs and manual workflows 

The large volume of applications that large commercial payer entities and Medicare and Medicaid experience causes applications to remain in queue for extended periods, even weeks. New providers lacking a dedicated enrollment team member to track their submissions, do not monitor their applications closely. As a result, new providers miss subsequent follow-up windows and do not respond in a timely manner to inquiries from the payer entity, which delays the approval process. 

Multiple applications across different insurance networks 

The complexity of an existing application to join one plan is compounded when applying additional plans. For example, in addition to Medicare and Medicaid, there may be 2 to 5 additional commercial plans (e.g., Blue Cross, UnitedHealthcare, Aetna). The added workload associated with tracking multiple applications and respective deadlines can cause a practice to lose track of deadlines, miss effective-date windows, or allow authorizations to lapse prior to initiating billing. 

By managing the challenges, healthcare providers can join insurance networks more quickly.  

Steps to Join Insurance Networks Faster 

Following the set of steps as outlined below will help you eliminate months from your waiting time by creating a repeatable workflow that simplifies the entire process.  

Prepare your core data 

Before you begin applying to payers, collect the following data: 

• Current medical and state licenses 

• DEA number, NPI number, taxonomy codes 

• Board certification(s), training documentation, etc. 

• Malpractice insurance coverage certificate 

• EIN (Employer Identification Number), W-9, and practice address setup 

• CAQH profile updated with all associated affiliations and ID numbers 

Use authoritative sources (for example, a credentialing checklist in addition to a CAQH profile) to ensure that each applicant has access to identical information. 

Enroll payers as per priority   

Do not let onboarding fatigue get you down, so avoid trying to do it all at once. Instead, identify your top 5-7 payors (e.g., Medicare, Medicaid, Aetna, Cigna, UnitedHealthcare, and the local HMOs), as well as how they would prefer their application submitted (i.e., via CAQH, through their web portal, via PDF, or through a third-party vendor).  

Create ‘batch weeks’ and complete and submit 2 to 3 applications per week. Then move on to the next group. 

Learn the CAQH enrollment process 

CAQH is the core of most modern insurance credentialing network enrollment processes for many commercial payers.  

To complete this faster:  

• Complete your CAQH profile prior to contacting any payer. 

• Upload all your licenses, certifications, and references in a single sitting, locking it in. 

• Set regular reminders to update any changes (address, phone number, etc.), so subsequent applications will have access to the same information. 

• Payers that use CAQH will automatically pull most of your application information from the CAQH site. 

This reduces the amount of manual entry required by the payer and may shave days or weeks off the manual-entry phase. 

Utilize standard templates and checklists 

Develop templates for the following items which you can use repeatedly: 

• Practice profile pages (address of practice, EIN, tax ID, group structure) 

• Attestation statements and authorization forms  

• Narratives regarding malpractice claims and prescribing types  

Using a checklist per payer will allow you to avoid having to rediscover requirements for each application submitted and minimize the potential for omitting a small field that may delay processing of the application. 

Create an internal tracking system 

Utilizing either a simple spreadsheet or a credentialing software to keep track of the following will allow you to identify stalled files prior to their expiration dates:  

• Date the application was submitted  

• Name of payer and type of plan  

• Actual response dates compared to expected response dates  

• Additional information requests from payers  

• Scheduling follow-up calls with payers  

Having a view of what has happened with each file will enable you to identify stalled files before they miss their effective dates. Incorporating these steps into your credentialing process will allow you to transition from a reactive, ad hoc approach to a more efficient and faster provider enrollment process.  

How Credentialing Accelerate Network Enrollment 

Professional insurance network enrollment services and provider enrollment services are designed specifically to alleviate the issues listed above. They assist doctors, specialists, and clinics in joining insurance networks faster by reducing administrative burden and maintaining workflow orders. 

How provider enrollment services can help you out

Most companies that offer professional credentialing services will typically do the following:  

• Complete NPI, CAQH enrollment process, and PECOS registrations. 

• Gather and organize physician documentation and verify it to meet payer requirements. 

• Send completed applications to multiple payers through the most efficient portal and workflow possible. 

• Track each application as it moves through the verification, committee review, and contract execution process.  

• Provide reminders regarding recredentialing cycles and notify you when your next cycle is due and the expiration date of your current cycle.  

By offering this full-service approach, the credentialing company will enable clinic staff to focus their efforts on patient care. The credentialing company will manage the timeline and keep following up with the payer. 

Professional services speed up the insurance credentialing process

Since credentialing companies are working with many payers, they are aware of the following:  

• Who the fast movers are, for example, some Medicare Intermediary contractors will complete the credentialing process within 40 days, while others will take 80 or more days.  

• Which portals are capable of batching submissions or automatically pulling data from CAQH. 

• How to format answers to verification requests to ensure that they pass the primary-source check quickly.  

In addition to these items, many credentialing companies maintain long-term relationships with the payer’s representatives. These relationships improve the speed of response and eliminate the delays in which submitted information disappears for weeks. 

Expert services like Credex Healthcare process multiple applications across networks simultaneously

One of the largest advantages for clinics and multi-specialty groups is that the credentialing firm can submit applications to multiple payers simultaneously, rather than sequentially. This simultaneous processing may shorten what could have been a sequential 90-day process to a single 90-day process, allowing the addition of several payers at the same time and resulting in quicker revenue growth.  

Tips for Smooth and Faster Enrollment 

In addition to establishing processes and outsourcing, there are several practical best practices you can use to enroll in insurance networks more quickly and avoid delays. 

Plan ahead 

The most common mistake is waiting until the practice opens to start credentialing. Start early, at least 4 to 6 months prior, to give yourself buffer time for slower payers and unexpected verification delays.  

Plan accordingly:  

• When starting a new practice  

• Opening a new location  

• Adding a new physician or a specialist

Keep CAQH ProView updated 

Treat your CAQH ProView profile as an asset instead of just a one-time form. Update any changes (new phone number, address, affiliations, certifications, etc.) within 30 days. Many payers will consider CAQH updates as primary-source-level verification. This could reduce the amount of documentation needed for future applications. 

Create a standard malpractice narrative 

Malpractice carriers and insurers tend to view different versions of ‘what happened’ by multiple providers working at the same practice as red flags. Collaborate with your malpractice carrier and legal counsel to develop a standardized template for disclosures. When submitting your applications, this will ensure your application packets look the same. 

Assign one provider enrollment coordinator 

 Identify one person or company responsible for managing all aspects of credentialing. They will be responsible for:  

• Controlling all documentation and signature requirements 

• Creating the master tracking system  

• Coordinating with both payers and internal staff  

• Avoids confusion from multiple administrators and ensures consistent follow-up

Utilize technology  

There are several tools available to help streamline the credentialing process. Using the right tools, such as modern credentialing platforms, EHR systems, or add-ons, can help you join insurance networks faster and reduce the need to manually log into 10 or more separate portals per day. 

Some examples of tools include:  

• Automating CAQH updates  

• Exporting bulk payer applications  

• Creating real-time status dashboards

Negotiate and protect effective dates with payers 

Payers will often choose effective dates that are months after they approve your application. If you have a strong provider enrollment services team working for you, they may be able to negotiate an effective date closer to the time you receive approval, or possibly even grandfathered terms, especially if you’re entering a high-demand specialty or an underserved area. 

FAQs 

How long does it take to join an insurance network? 

The average length of a first-time credentialing cycle takes approximately 90 to 120 days. Some credentialing cycles may take 6 months, depending on how quickly the applicant completes their application and how quickly payers verify it. Medicare and some Medicaid plans typically process credentialing cycles more quickly (typically 45 to 90 days). Credentialing cycles for large, commercial payers typically take 3-6 months to complete.  

Some of the factors that allow for the credentialing cycle to be processed quicker:  

• Applications that are complete and have no errors  

• Primary source responses from the applicant that are received quickly  

• Completion of CAQH application as soon as possible  

• Follow up with the payers on the applicant’s behalf to ensure timely credentialing completion 

Can I join multiple insurance networks at the same time? 

Yes, applicants for credentialing can and should apply to multiple insurance networks at the same time. Applying for credentialing with multiple networks at the same time can reduce the amount of time it takes to receive full payer coverage. It can also minimize the risk of delayed payment. However, applying for multiple credentialing opportunities at the same time can create a significant administrative burden. Therefore, many healthcare facilities hire professional medical credentialing companies to assist them in the credentialing process. These companies provide dedicated enrollment teams to manage the credentialing process in parallel. 

What documents are required for insurance network enrollment? 

Documents needed typically include all current medical licenses and DEA registration, NPI and practice EIN, documentation of education and residency, board certification certificates, certificate of malpractice insurance and claims history, CAQH profile ID and completed CAQH packet, practice address, W-9, and banking information, and professional references, and disclose any events. Some payers may also ask for additional items such as documentation of hospital privileges, quality reporting attestations, or specialty-specific certifications. 

How can professional services speed up the process? 

Professional medical credentialing can speed up the process by preparing and standardizing applications to meet the expectations of each payer on the first try. Managing verification by calling boards, insurers, prior employers, so you don’t rely on slow email chains, tracking every file through all stages, and escalating stalled cases before they miss deadlines, and managing recredentialing and renewals so your network status never expires. 

Conclusion  

Faster enrollment into insurance networks is not about taking shortcuts. It is about making the credentialing process systematic through effective use of CAQH and by outsourcing the complexity of the credentialing process to experienced credentialing services.  

For physicians, specialists, and clinics, this means less time in getting paid (time-to-revenue), reducing the number of administrative mistakes made during the enrollment process, and more time to focus on their patients and grow their practice. If you are looking to join insurance networks faster and would like to reduce the burden of manually enrolling providers, consider working with a provider enrollment firm that offers:  

• Credentialing and provider enrollment assistance from beginning to end  

• Support with CAQH and enrollment with Medicare and Medicaid  

• Following up and tracking all interactions with each payer