Outsourcing Credentialing: Pros, Cons, and What to Look For
Insurance credentialing is one of the most time-consuming administrative tasks in healthcare. With constant payer changes, strict documentation requirements, and long approval timelines, many practices wonder:
Is it time to outsource credentialing?
Here’s a concise look at the pros, cons, and how to choose the right partner.
Why Practices Outsource Credentialing
Faster, More Accurate Approvals
Credentialing experts handle applications daily. They know payer requirements, typical pitfalls, and how to avoid delays—helping you get in-network faster and reducing denial or rejection risk.
Less Administrative Stress
Outsourcing frees your team from chasing down documents, following up with payers, updating CAQH, monitoring recredentialing timelines, and resolving errors.
This allows providers and administrators to focus on patient care and business operations instead of paperwork.
Better Compliance + Tracking
Credentialing companies typically have tracking systems for:
Expirables
Revalidations
Contract renewals
Payer policy changes
Timelines and documentation requirements
This ensures nothing slips through the cracks—protecting your revenue.
Predictable Costs
While salaries and training costs for in-house staff can fluctuate, outsourcing provides fixed, predictable pricing (per provider, per month, or per project).
Faster Revenue Growth
The faster a provider is credentialed, the faster:
You can submit clean claims
You can join new networks
You can expand your patient base
Your practice can scale
Credentialing delays directly impact cash flow—outsourcing helps minimize them.
Potential Downsides
Less Direct Control
Outsourcing means your team isn’t personally handling each step.
A reputable credentialing partner should offer strong visibility, but it’s still an adjustment if you’re used to full in-house control.
Cost Considerations
While often cheaper than hiring a full-time credentialing specialist, outsourcing still comes with a fee.
For new or small practices, this may feel like an added expense—even though it often prevents revenue loss.
Quality Varies Widely
Not all credentialing services are equal.
Some:
Don’t provide transparency
Outsource work overseas
Lack payer communication skills
Move slowly or fail to follow up
This is why choosing the right partner matters.
Still Requires Provider Participation
Even the best credentialing service will need:
Signatures
Access to documents
Provider profile approvals
Communication for missing items
Credentialing is collaborative—outsourcing doesn’t eliminate your involvement, but it does streamline it.
What to Look For in a Credentialing Partner
If you decide to outsource, choose a partner who offers:
Full Transparency
You should receive:
Status updates
Timelines
Copies of submitted applications
Clear tracking of every step
Avoid companies that “go dark” or won’t show their work.
Insurance Expertise
Look for professionals who:
Work with your specialty
Understand state and payer requirements
Have experience with Medicare, Medicaid, and commercial plans
Can anticipate issues rather than react to them
Technology + Human Follow-Up
Credentialing requires both:
Software tools for tracking
Real human follow-up with payers
Avoid companies relying solely on automation—credentialing still requires conversations, corrections, and advocacy.
Clear Pricing Structure
Common models include:
Flat per-provider fee
Monthly subscription
One-time project fee
Add-on services for maintenance, CAQH, or recredentialing
You should know exactly what’s included before signing.
Ongoing Credentialing Maintenance
Credentialing doesn’t end when you’re approved.
Choose a service that can also:
Maintain CAQH
Track expirables
Handle revalidations
Manage new state licenses
Add new locations or tax IDs
This protects your practice from costly enrollment lapses.
Bottom Line
Outsourcing credentialing can save time, reduce errors, protect revenue, and support long-term growth—as long as you choose a knowledgeable, transparent partner. Honored Healthcare Systems is that trusted partner. Get Started — Honored Healthcare Systems
