Top 5 Healthcare Credentialing Mistakes
Healthcare credentialing can quickly become a tangled web of confusion with endless forms, evolving regulations, and high-stakes outcomes. Mistakes are common, but they’re not inevitable. Most credentialing pitfalls can be avoided entirely with the right systems and awareness.
Let’s talk about what the common mistakes are and how healthcare organizations can prevent them.
When credentialing is overlooked or mishandled, it causes serious repercussions like lost revenue, legal risks, and patient safety concerns. For example, granting privileges to a provider with outdated or incomplete credentials could expose your organization to malpractice claims or result in denied reimbursements from insurers.
And in today’s fast-paced healthcare environment where staffing shortages, provider turnover, and clinic expansions are the norm. Consequently, credentialing can easily fall through the cracks.
Staying ahead and aware of the most common mistakes is the first step in preventing them.
When you’re short-staffed or racing to meet demand, it’s tempting to bring providers on board before their credentialing is fully complete. However, this shortcut can have long-term consequences.
Whether it’s a missing license check, an incomplete background review, or a skipped verification, allowing a provider to start seeing patients prematurely can jeopardize compliance, patient safety, and reimbursement.
Set a clear internal policy that ensures no clinical activities can begin until credentialing is fully completed. Make sure to keep all documents, licenses, and communications organized in one central location, preferably in a digital provider profile. This helps everyone stay on track and prevents any unnecessary delays.
Credentialing isn’t a one-and-done task. Providers must be re-credentialed regularly, and licenses must be renewed on schedule. Letting these dates slip can halt reimbursements and disrupt patient care.
Worse still, many payers will require a full re-credentialing from scratch if deadlines are missed. This is time-consuming, costly, and frustrating.
Once initial credentialing is complete, log all expiration dates and set automated reminders 90–180 days in advance. This gives providers and staff enough time to gather documents, renew licenses, and submit updated information without last-minute stress.
Credentialing applications demand a massive amount of information. It’s easy to miss a tiny detail, an outdated phone number, a blank field, or a typo in a license number. Unfortunately, payers aren’t forgiving.
Even a tiny error can cause the application to be rejected or delayed, creating a domino effect that slows the entire process and puts patient scheduling on hold.
Double-check every application before submission. Encourage providers to update their information regularly, especially after moving offices or changing contact details. Use a checklist or credentialing platform to flag missing fields and ensure nothing slips through the cracks.
Credentialing isn’t a quick task. Each step, collecting documents, verifying information, communicating with payers takes time. Poor planning or unrealistic timelines can delay start dates and hurt your organization’s bottom line.
In fact, according to industry reports, a physician not seeing patients due to credentialing delays can cost a healthcare organization thousands per day in lost revenue.
Start the process early, ideally 90 days before a provider’s start date. Break the process into clear, manageable steps, and track each milestone. Credentialing software can help automate reminders, flag delays, and reduce bottlenecks.
Credentialing rules vary by state, specialty, and payer – and they’re constantly changing. Whether it’s a new form, updated licensing requirement, or payer-specific documentation, falling behind can slow your process and lead to rejected applications.
In busy healthcare settings, staying updated is often easier said than done.
Assign a team member to monitor updates from payers and regulatory boards. Sign up for official newsletters, participate in webinars, and hold monthly check-ins to review the changes. Share these updates across your credentialing team to stay aligned.
Whether you’re managing credentialing for a private practice or a multi-location hospital, we help streamline the process so your providers stay compliant and focused on delivering care not chasing documents.
