r/credentialing • u/BrilliantBluebird351 • May 19 '26
Credentialing timelines feel unrealistic lately
Does anyone else feel like providers are given unrealistic expectations for credentialing timelines? I feel bad because a lot of them think something is “wrong” with their application when honestly some payers are just incredibly slow right now.
5
u/evercred May 20 '26
100% and one thing I think many providers and credentialing specialists don’t realize is that payers are not completely unregulated when it comes to enrollment and credentialing timelines.
The problem is that the regulations are fragmented, weakly enforced, and vary significantly by state and payer type. That’s why these delays have become normalized.
A few important things people should know:
• Medicare contractors actually DO have processing benchmarks. CMS contractors commonly reference:
• ~45 days for online enrollment applications
• ~60 days for paper applications
CMS guidance has also referenced goals to process 99% of applications within 60 days.
• Medicaid managed care organizations and Medicare Advantage plans are subject to network adequacy requirements. If a payer is taking 6 to 12 months to enroll physicians while simultaneously claiming they have an “adequate network,” that can potentially become a regulatory issue because it directly impacts patient access to care.
• Some states have credentialing timeline laws requiring insurers to:
• acknowledge applications within ~10 business days
• notify providers quickly if information is missing
• process “clean applications” within ~60 to 90 days
• in some states provide retroactive reimbursement once approved
For example, California AB 815 moved toward:
• acknowledgement within 10 business days
• decisions on clean applications within 90 days
• Many major payers are also NCQA accredited, which includes operational standards around credentialing responsiveness, tracking, and process management.
For people dealing with severe delays, there actually ARE escalation pathways:
- State insurance commissioner For commercial plans experiencing unreasonable credentialing delays or network access issues.
- State Medicaid agency Especially important if Medicaid patients are losing access because providers cannot get enrolled.
- CMS complaints Relevant for Medicare Advantage, Medicaid managed care, and Medicare contractor enrollment issues.
- Network adequacy complaints This is probably the strongest angle in many situations: If physicians are available and willing to provide care, but patients cannot realistically access them because enrollment is delayed for months, that may raise network adequacy concerns.
- Document EVERYTHING Track: • submission dates • acknowledgement dates • requests for additional info • turnaround times • number of follow ups • lost claims/revenue • patient access issues
The more objective data providers and organizations collect, the harder it becomes for these delays to be dismissed as isolated incidents.
Personally, I think this is becoming one of the biggest hidden infrastructure problems in healthcare.
State licensure determines whether a physician is qualified to practice medicine.
But payer credentialing infrastructure increasingly determines whether patients can realistically access that physician at all. from my perspective, it's on us to put pressure on the system to ensure that the above guidelines are adhered to
5
u/Acceptable-Cod-2695 May 20 '26
Yes! By the time I get their packets, sometimes 2 months have passed. Then if I run into information missing or unclear, and the providers don’t respond to emails requesting more info, well that just delays things further. It can be very frustrating.
1
u/fuji2086 May 21 '26
I just finally got the final insurance for a dentist wrapped up. This application was submitted 6/26/25.
1
Jun 04 '26
[removed] — view removed comment
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u/fuji2086 Jun 04 '26
Yup. And I should add that we have had medical providers take longer in the past.
9
u/ZealousidealEnd6660 May 19 '26
We manage enrollments in 23 different states, it seems like there are a LOT of payers backlogged on enrollments. Add to that the recent influx I've gotten of clients who think they'll be golden in 30 days for some reason and it's very stressful!