How Long Does It Take to Get Credentialed?

If you want to start your healthcare career in the U.S. Healthcare industry, you must undergo medical credentialing. Moreover, it is a crucial but time-consuming procedure to ensure patients’ safety and the verification of their skills. Despite the fact that healthcare providers are aware of the significance of credentialing, they are curious: How Long Does It Take to Get Credentialed?

Companies that provide expert credentialing services are able to speed up the entire procedure thanks to the team’s expertise and knowledge. Additionally, they effectively and efficiently deal with delays. Also, there are a lot of things that could change how long it takes to register your business. Hence, this blog will cover all about the credentialing process, explain each stage, and factors that influence this timeline.

How Long Does It Take to Get Credentialed? 

Provider enrollment duration usually takes two months. However, credentialing timeline may differ due to many factors like your specialty, location, and complexity of application. Also, it usually takes longer for first-time credentialing than to get recredentialed.

On average, the credentialing timeframe for healthcare providers ranges between 60 and 120 days. However, it can differ due to the following reasons:

• Consider payer or insurance company.
• Determine specialty and location.
• Understand documentation process and time.
• Consider multiple network applications simultaneously.
• Plan for a 3-4-month window for credentialing.
• Be prepared for busy periods and additional screening criteria.
• Start procedure at least 120 days before practice.
• Add extra time to plan to handle unexpected credentialing delay reasons.

Typical Credentialing Timing by Step

As discussed earlier, How Long Does It Take to Get Credentialed depends on some factors. You can observe where time is wasted by splitting the licensing process down into its sections. There are regulations and prospective complications for each phase that might slow things down and modify your overall plan.

• NPI and license setup (1–2 weeks)

It usually takes 7 to 10 business days to receive your National Provider Identifier (NPI) via the NPPES system. If you supply the correct information from the beginning, however, the procedure may proceed quickly. Also, it only takes most physicians 30 minutes to complete their NPI application online.

Provider enrollment duration varies by state and practice, with processing times ranging from a week to months. Doctors should start planning early, as some states charge more for faster processing and others have strict schedules. Non-complete applications also take longer to process.

• CAQH creation and attestation (1–2 weeks)

To create a CAQH ProView page, suppliers must gather extensive information and fill out numerous forms. You may require the maintenance procedures every 120 days to maintain employment, and the process typically takes two to four hours. Making the page takes less time than filling out the forms, but making sure everything is correct the first time saves time. In most cases, profiles are processed within 24 to 48 hours by the CAQH system; however, it may take longer to correct and resubmit profiles that are missing information. Therefore, it can save you time to ensure that all paperwork is in order before you begin.

• Document prep (1–2 weeks)

To get credentialing applications approved, providers must have the proper documents ready, including professional licenses, legal insurance, education records, and job experience proof. These documents must meet specific style and date standards. Verified copies may take one to two weeks, depending on school processing time and licensing board processing time. Early preparation can prevent delays, as many suppliers are unaware of the time it takes to prepare and review their paperwork.

• Payer evaluation (30–90 days)

The insurance company’s assessment is the longest in the licensing process, involving primary source checks, security checks, and sector-specific research. Large insurer networks process applications faster due to dedicated teams and authentication systems, while smaller area payers may take longer due to fewer workers. Understanding the time it takes for each payer to make a payment helps set realistic targets. The review process may take longer if additional information is required.

• Contracting and onboarding (2–4 weeks)

The final hiring and training take place following the certificate’s evaluation. Depending on discussions, contract signing can take anywhere from one to two weeks. It may take longer to set up the provider lists and claim processing systems. Standard contract wording may be used, but larger organizations or specialist providers may negotiate more extended contracts.

 The final step goes more quickly when the parameters of the contract are known in advance. During contracting, settings for provider directories and internal systems are changed, and claim management may take a few weeks after the hiring process.

Factors That Can Delay the Process

There are a few typical credentialing delay reasons that might take longer than the usual 60 to 120 days.

• Incomplete or outdated documents

The most typical cause for delays is that the applications don’t include all the correct information. Also, it takes longer to amend and resubmit documents or certifications that are missing or have already expired. Most delays that may have been prevented can be avoided by carefully preparing before bringing in an application.

• Delays in background checks or reference verifications

If there are problems with background checks, the credentialing process might take a long time. Also, it may take longer to verify providers with complex work histories or licenses from more than one state. So, maintaining detailed records of all work acts makes the background check go faster.

• Missed attestation deadlines on CAQH

Every 120 days, CAQH asks providers to confirm their profiles to make sure the information they provide is correct. If you miss this deadline, your profile can become inactive. It could make it harder for payers to acquire your information and for you to get your credentials.

• Errors in your NPI or state license

It can be a problem if your NPI or state license has mistakes, like the wrong license number, end date, or names that don not match. Most of the time, these mistakes mean you need to ask for changes, start some steps over, and wait longer to get your credentials.

• Mismatched information between systems (like PECOS, CAQH, and payer forms)

Tools like PECOS, CAQH ProView, and payer portals validate your information twice. If your name, home address, licence, or credentials are different on multiple platforms, it could cause confusion, get your application turned down, or make you have to show more verification.

• Staffing shortages at insurance companies or credentialing departments

It’s not always your fault when you run out of time. When enrolment is high, insurance companies or departments that grant credentials may not have enough workers or may be behind on their duties. This can make the evaluation process take a lot longer than the normal 30 to 90 days.

Strategies to Speed Up Credentialing

Many strategies can help you speed up the process and manage the credentialing cost.

•         Preparing ahead of time reduces credentialing timeframe and delays.

•         Ensure all necessary documentation is in order before starting applications.

•         Establish early contact with certification managers at insurance companies.

•         Regular follow-up communications help identify issues early.

•         Speed up the process by sending complete forms with required documents.

•         Answer inquiries within 24 to 48 hours.

•         Keep CAQH verification status updated.

•         Use certified mail for vital documents.

•         Keep detailed records of all talks and entries.

•         Consider using certified services with professional expertise and contacts.

Consequences of Delays on Practice Launch

Late credentials can have a significant effect on the finances of both new and old practices, costing firms thousands of dollars a month. Delays can throw off growth predictions, make it hard to schedule appointments, and hurt cash flow. Longer license delays can also make it harder to get new patients and keep old ones, which could harm relationships with coworkers and doctors.

Fair deadlines help you keep your professional relationships while you get your certifications. Flexible operations planning can help you deal with changes in certification schedules, which makes it easier to prepare for staff and resources. Setting reasonable deadlines might help keep professional connections strong as you deal with these problems.

Conclusion: Build your timetable with buffers and follow‑up discipline

To figure out How Long Does It Take to Get Credentialed, you need to prepare to take into consideration both usual deadlines and unforeseen delays. A good credentialing process needs a lot of planning, getting ready, and talking to credentialing administrators all the time. How you handle your papers and how quickly you answer to requests also have a big effect on your overall schedule.

So, start the process of collecting your certifications at least 120 days before you want to establish your firm. Also, make sure you retain precise monitoring systems and follow-up strategies so that you stay working toward completing your registration.

Want to accelerate your credentialing process? Consult us today. Our expert at credexhealthcare.com will handle the entire credentialing procedure efficiently so you can start and grow your practice quickly.  

FAQs:

What if one payer takes longer than expected?

Keep attempting to collect credentials from other payers while also checking in with the late payment on a frequent basis. You could start with the payers that send the most patients to your firm.

Does re‑credentialing take less time?

Yes, it normally takes 30 to 60 days to get your credentials back because most of the material has already been looked at. But the deadline could be pushed back if your skills or business change a lot.

Can credentialing overlap with contracting?

Some purchasers chat about contracts while the credentials are being examined, but the actual contract is usually signed after the credentials have been reviewed and authorized. This overlap might make the whole process shorter.

What part of the process takes the longest?

The payer review is generally the longest stage, taking 30 to 90 days. This is because insurance companies have to confirm all the information against key sources and perform background checks.

Are there expedited credentialing services?

Some certification businesses will do things quickly for more money. The actual timetable for customer review, on the other hand, doesn’t alter significantly depending on which service provider is employed.