Top 5 Mistakes Providers Make During Credentialing—and How to Avoid Them
Credentialing is a critical step for providers who want to accept insurance and get reimbursed for their services. Unfortunately, many providers run into delays—or even denials—because of avoidable mistakes in the process.
The good news? With the right preparation and awareness, you can sidestep these pitfalls and move through credentialing more smoothly. Let’s break down the top five mistakes providers make during credentialing—and how to avoid them.
1. Submitting Incomplete Applications
The mistake: Providers often miss key information like work history, malpractice insurance details, or peer references. Even a single missing field can stall an application for weeks.
How to avoid it: Use a credentialing checklist before you apply. Double-check that every section of the application is filled out and that your supporting documents are current.
2. Not Updating CAQH Regularly
The mistake: Many payers pull provider data directly from the CAQH database. If your profile is incomplete or not attested, applications can’t move forward.
How to avoid it: Log in to CAQH at least every 90 days to update your profile and re-attest. This small habit keeps your data current and avoids unnecessary rejections.
3. Overlooking Expired Documents
The mistake: Providers sometimes submit outdated malpractice insurance, licenses, or certifications without realizing they’ve expired. Payers will not process outdated documents.
How to avoid it: Keep a digital file of all your licenses, certifications, and insurance with reminders set for renewal dates. This way, you always submit the most current version.
4. Ignoring Follow-Up Requests
The mistake: Credentialing specialists and payers often reach out for clarifications or missing pieces. If providers delay in responding, their application stalls—or worse, gets closed.
How to avoid it: Check your email regularly (including spam folders) and respond quickly to credentialing requests. A 24–48 hour turnaround can keep your file moving.
5. Assuming Credentialing Is a “One and Done” Process
The mistake: Many providers think credentialing only happens once. In reality, it requires re-credentialing every 2–3 years and updates anytime you change locations, groups, or services.
How to avoid it: Stay proactive. Track renewal cycles and keep your documents updated even between applications. This helps you avoid coverage gaps and reimbursement delays.
Final Thoughts
Credentialing mistakes cost providers valuable time and money—but they’re entirely preventable. By staying organized, updating documents, and responding quickly to requests, you can avoid delays and focus on what matters most: caring for your patients.
Want to make credentialing easier? Hire a professional who will keep track of the entire process, use their contacts to expedite the entire process, and keep you compliant on a consistent basis. Get Started.
