Every new provider you hire is an investment. But until that provider is credentialed and enrolled with your payers, they can’t bill for most of the patients they see. For many practices, that gap stretches for months, and the lost revenue adds up fast.
Medical credentialing services close that gap. Below, we break down how provider credentialing works, where it usually stalls, and how to decide whether to keep it in-house or bring in outside help.
Medical credentialing is the process of verifying that a provider is qualified to deliver care. It confirms education, training, licensure, board certification, work history, and malpractice history.
Credentialing is often paired with payer enrollment, which is the separate step of getting a credentialed provider contracted and loaded with each insurance plan. Practices need both. A provider can be fully credentialed and still be unable to bill a payer they aren’t enrolled with.
Plan on roughly 90 to 120 days per payer, and sometimes longer. Timelines depend on the payer, the state, and how complete the application is on day one.
The most common causes of delay are preventable:
The single best move? Start credentialing as soon as an offer letter is signed.
When a provider is seeing patients but not yet enrolled, the practice has three bad options: delay the start date, hold claims and hope for retroactive coverage, or write the visits off. Each one costs money.
Delays also affect patients. They may be told a provider is out of network or be rescheduled with someone else. That friction shows up in reviews and retention.
|
In-house |
Outsourced credentialing services |
|
|---|---|---|
|
Best for |
Large groups with a dedicated, experienced coordinator |
Small and mid-size practices, or groups adding providers often |
|
Cost |
Salary, benefits, and training for staff |
Per-provider or per-payer fee, scaled to need |
|
Expertise |
Depends on one or two people |
A team that works with many payers daily |
|
Risk |
Work stops when that person is out or leaves |
Coverage and tracking stay consistent |
Many practices land in the middle. They keep some tasks in-house and hand off the rest. That’s exactly why we build credentialing as a custom service rather than a fixed package.
The Mercury Group offers a full range of provider credentialing services that can be tailored to your practice. We can manage initial credentialing and payer enrollment for new hires, maintain CAQH profiles, track expirations, and handle recredentialing. Or we can step in on just the pieces your team doesn’t have time for.
What’s the difference between credentialing and privileging?
Credentialing verifies a provider’s qualifications. Privileging is a hospital or facility granting a provider permission to perform specific procedures there.
How often do providers need to be recredentialed?
Most payers and accrediting bodies require recredentialing every two to three years. Check each payer contract for its cycle.
Can a provider see patients before credentialing is complete?
They can see patients, but billing those visits is risky. Some payers allow retroactive effective dates; many don’t. Confirm with each payer before scheduling.
Do I need to credential a provider who is already credentialed elsewhere?
Yes. Enrollment is tied to your practice’s tax ID and location, so a provider joining your group needs to be enrolled under your practice.
Credentialing doesn’t have to hold up revenue. Book a free discovery consultation and we’ll review where your credentialing stands and build a plan that fits your practice and your budget.
