Credentialing has always been essential to keeping providers in-network and reimbursable. What’s changed is the volume, pace, and ongoing oversight now required to maintain credentialing status, especially as payer processes evolve and provider directory accuracy requirements become more demanding.
In a recent Birmingham Medical News feature, Kassouf Healthcare Tax and Advisory Group Principal Stewart Garner, MSHA, CMPE described how new pressures, particularly those connected to the No Surprises Act and an increased emphasis on accurate provider directories, have made credentialing significantly more complicated for provider organizations.
For practices, this isn’t just “back office” work. When credentialing doesn’t stay current, the ripple effects can show up quickly in reimbursement disruption and patient access.
Why credentialing feels harder now (and why it matters)
Garner highlighted a few reality checks many practices are experiencing:
- Directory maintenance is ongoing. Practices may need to re-attest directory information on a recurring cycle (the article references an every‑90‑days cadence), including details like office locations, contact information, and whether physicians are accepting new patients.
- Payers increasingly rely on centralized platforms. Instead of traditional paperwork alone, payers may pull information from platforms such as the Council for Affordable Quality Healthcare (CAQH), which means keeping provider information accurate across systems is critical.
- Credentialing timelines are hard to predict. The feature notes that payer processing speeds vary widely, making it difficult to give confident approval timelines, especially when onboarding new providers.
- Consequences can be significant. The article explains that if credentialing isn’t maintained “consistently and within the desired time frame,” providers can be dropped from a network, and practices may face denials or reimbursement delays until records are reinstated.
- Patient access can be affected. When network participation and reimbursement are uncertain, the article notes practices may be forced to postpone appointments or temporarily stop scheduling patients covered by certain plans
One additional point the article emphasizes is that independent practices can feel these issues more acutely because large systems often have dedicated credentialing departments, while smaller practices may be balancing credentialing alongside billing, payroll, and operations.
What practices can prioritize right now (without adding more burden)
Credentialing may never be simple, but the sources point to a few practical priorities that can reduce risk:
- Treat credentialing as an ongoing operational function, not a one-time task.
- Keep CAQH and related payer profiles current.
- Build in tracking and active follow-up after submission.
- Plan for enrollment and contracting lead times when onboarding providers.
At Kassouf Healthcare Solutions, our focus is on helping physician practices navigate operational complexity so leaders can stay focused on care delivery and practice performance. Though Kassouf Healthcare Solutions does not provide credentialing services directly, many of our clients receive credentialing and provider enrollment support through Kassouf’s dedicated credentialing team. If you are hiring new providers, expanding locations, or trying to prevent enrollment lapses, their experts are here to help.
Visit Kassouf’s Credentialing Services to learn more.