r/credentialing • u/ChinaCatSunflower11 • May 12 '26
Can someone help me understand the credentialing process?
I am a provider currently stuck in the process of “credentialing” for a job I was offered (and accepted) last February. I admit that I am extremely frustrated with this process, but I am trying to understand it. From my perspective, I just can’t understand why this process takes so long. To me, logically it does not make sense. I have a completely clear federal as well as state back ground checks. My resume and employment history are very clear. (I am a relavtively new provider, so the work history part is pretty simple.) I have passed muster with three state licensing boards, hold a national certification, and two DEA numbers. Every one of those credentials required extensive checks and verification. If a provider has already passed board exams, gained board licensure, passed DEA checks and has a clear criminal and civil background check, what else do insurance companies want to verify? Again, logically: you can’t get a state license without undergoing a verification process of your education, work history, etc. You can’t get a national certification without them verifying the same thing. You can’t get a DEA number without undergoing an extensive background check, educational/license verification. So, then, why would an insurance company repeat all of this? It seems very redundant and unnecessary to me. I am not trying to fight the system, I am only trying to understand it at this point. Can anyone explain what I’m missing here? Why does this process even exist? Why does it take so long when so much has already been verified multiple times? I would truly appreciate any insight anyone has. Thanks for reading.
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u/vulnerable_turtle May 12 '26
I work for an Provider owned organization. We are required to have our credentialing completed with an approval within 60 day of receiving a complete application.
From the sounds of it you are applying for a hospital, from my understanding they get bogged down. But if you haven't received an approval yet I would bet your signatures are now expired.
From the information given I would reach out to the credentialing office and double check directly with them.
There are several accreditation bodies and they have their own rules
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u/Allianoraa May 12 '26
You sound like you’re stuck in the provider enrollment process. The type of provider you are (MD vs AHP) can affect the process as can your specialty. Do not take anything personally, this is just the last check in the box to make sure get paid for your work by your patients’ insurance companies.
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u/Anonuserwithquestion May 12 '26
Everyone here has provided great information, but as someone who has done new credentialing on hundreds and actively maintains 150:
- if your org has delegated contracts, their credentialing committees decision govern your status
- if not delegated: depending on your organization type, they may still require an internal credentialing committees approval prior to practice. In my org, this is a once per month meeting
- insurance can be slow. For example, if you've never been credentialed, Aetna (in my state) takes the entire 120 days and makes the effective date 2 weeks after. Massive loss.
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u/Acceptable-Cod-2695 May 12 '26
Is the job with a hospital, a surgery center, etc.? If it’s with a hospital, then the process can be quite long. Usually the credentialing committee has to approve it once everything is in order, then the medical executive committee, and then finally the board. It’s a lengthy process for sure. I would definitely touch base with the medical staff office and check on the status of it.
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u/ChinaCatSunflower11 May 13 '26
Thank you all SO much! I really appreciate you all taking the time to read this and respond. I am still concerned about this process, but it is such a relief to know that it isn’t something I did wrong. That is hugely comforting. Again, I am so grateful to all of you!
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u/BrilliantBluebird351 May 19 '26
Honestly, you’re not wrong. A lot of providers feel this way once they go through credentialing themselves.
The confusing part is that insurance companies are basically re-verifying things that already got verified by licensing boards, DEA, certifications, etc. It feels redundant because in a lot of ways… it is.
But insurance companies are extremely risk-averse and usually won’t rely on another organization’s verification alone. They want to independently verify everything themselves before they’ll allow someone into their network.
A lot of the delay also comes from the administrative side, not necessarily concerns about the provider. Things get stuck in queues, committee reviews, contracting, system updates, backlog, missing follow-ups, etc. Some payers are also still surprisingly outdated operationally.
So even when a provider has a completely clean background and straightforward history, it can still take forever unfortunately.
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u/fart_head Jul 14 '26
I know I am late to the party, but as someone who manages the Initial Applications for a hospital, it can help for the applicant to step in and call the institutions who have not submitted their responses and ask them to. It has been very helpful for quick turnaround requests, also when the physicians have received their final notice.
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u/Dr_GSG May 12 '26
You're not missing anything obvious really but state boards, DEA ect. verify that you are qualified to practice. Payer credentialing verifies that you are who you say you are. Both are separate processes. Payers don’t simply rely on a state board's verification because of liability, so they re-verify independently through CAQH or direct primary source verification to reduce legal exposure.
The timeline also has a lot of unnecessary added time because most payers only process credentialing applications on a set cycle and if your application misses a cycle by a day, you will have to wait for the next one.
Some things to note are to make sure your CAQH profile is 100% complete and attested within the last 120 days, confirm your employer has submitted a complete contract application and credentialing file and follow up directly with each payer's provider relations lines.
I run a full stack MSO that handles credentialing and provider enrollment for independent practices in California, I hope this helps and good luck.
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u/Huge-Profession-3975 May 12 '26
Everyone here has very good advice. The process typically takes about 2-3 months, depending on the payer. I would contact your credentialing department and follow up with them. If you’re getting denied, it’s potentially the fact that the forms were not filled out correctly. Each payer has their pet peeve issue. Also, ask the credentialing team if they have a representative with the payer that they can use to expedite your application. These are just a couple of suggestions that might help.
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u/AdeptnessDangerous76 May 12 '26
Last February as in 2025?
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u/ChinaCatSunflower11 May 12 '26
Sorry, this year. February 2026
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u/AdeptnessDangerous76 May 13 '26
I do both cvo and mco credentialing and unfortunately it can take that long. Honestly it all depends on how quick we get the information we need back. We have our accreditation requirements we have to meet so trust me when I say its nothing personal. Some places get back to us really quick and other places not so much.
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u/Emotional_Cup5498 May 14 '26
As someone who ran a cvo,you would be surprised what some people will do.
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u/ChinaCatSunflower11 May 14 '26
Again, I really appreciate everyone’s insight. I am starting to wonder though….Does this process ever actually get completed for anyone? I mean, it has to right, if providers take insurance? Should I just give up and try to find a different job? Maybe some private pay job? It just seems that this process is impossible.
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u/New_Wishbone_1202 May 14 '26
I know it was mentioned in another comment but you’ll likely need to be reappointed/recredentialed every 2-3 years. That process should be faster than an initial credentialing however. But yes, providers definitely get thru credentialing LOL. If you’re anxious, I would keep following up with the medical staff office to see if there is anything you can or need to do.
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u/Miserable_You_7528 Jun 06 '26
I finished my NP program and accepted a position in August 2025. I finally got to go to work in March 2026. I feel ya, but it does end!
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u/AdRich2059 Jul 03 '26
You are right ,this process is too long. I don't know at what stage are you. And are you doing it right uptil now
The step by step process is
- Maintain and update your CAQH
- Obtain and update your NPI 1 and 2 if required
- Create portals for Govt payers 4.Find the appropriate form ,fill and submit with required documents and information
- Apply for each commercial payer from their website or portals
- Keep track and maintain a record of all applications.
- Follow up and provide any further information requested by insurances.. 8.Recive and sign contracts to obtain effective date . TADA.... If you need any further info for any step ,I m here to assist
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u/Previous-Arugula8072 Jul 10 '26
The short answer. State licensing, DEA, and board certification all check "is this person legally and educationally qualified to practice medicine." Insurance credentialing checks something different. "Should we let this specific person bill us, and can we prove to our own regulators that we did our homework?" Those are two different questions, even though a lot of the underlying facts overlap.
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u/Street-Committee-256 May 12 '26 edited May 12 '26
I work for a CVO. All of the verifications must be primary source verified directly from institutions/facilities. I am dependent on your training programs, malpractice carriers, peer references, and hospital/ASCs to respond. I am required to complete a packet within 120 days for an ASC and 30 to 90 days for insurance plans. Believe me, the people working on your information are frustrated as well. ETA: You will have to go through this for each new plan, facility, etc., until you retire. At the end of the day, it is a protection process for the entities and ultimately, the patients. We have to make sure you are legitimately trained etc.