Insurance credentialing reminds one of filling out a whole bunch of forms: tedious, frustrating, and excruciatingly slow. Yet, without credentialing, no insurance billing and no growth of practices happens, leaving providers wondering what they have to do to grow their practices. How long does it take, and what can they do to speed it up?
This blog aims to provide estimated timelines, what determines those timelines, and how to handle slow delays.
What Is Insurance Credentialing and Why Does It Matters?
Insurance credentialing takes time. Insurers will want to confirm providers’ qualifications and background checks before they can bill insurance. This includes verifying the following: licenses, education, training, work history, and insurance billing history.
Credentialing lets insurance providers ascertain that a medical professional meets the basic medical, ethical, and professional standards before they process any insurance claim. Credentialing is done for claims to be paid without delays, and for the stalling patients’ trust to be paid that their claims will be promptly settled.
Physicians, nurse practitioners, and other medical specialists are all one large practice complex. Once compensated for the practice, they can grow the practice and expand services offered.
Average Insurance Credentialing Timeline
The insurance credentialing process usually takes 90 to 120 days (3–4 months) to complete.
- Application preparation: 1–2 weeks
- Primary source verification: 30–60 days
- Payer review and approval: 30–60 days
That said, no two cases are alike. Some credentialing processes wrap up in 45 days, while others drag on for six months — especially if forms are incomplete or payers request corrections.
How Long Does It Take to Credential a Provider Who Is Already Licensed in a State?
If a provider is already licensed in the state where they plan to practice, credentialing can take 60–90 days on average.
Being licensed helps speed up verification because state licensure is one of the key requirements. However, providers still need to submit documents for:
- Board certification verification
- DEA registration
- Malpractice insurance
- Work history and references
Pro tip: Having an up-to-date CAQH profile (Council for Affordable Quality Healthcare) is one of the quickest ways to decrease credentialing time dramatically. Most payers retrieve provider data directly from CAQH, so keeping it up to date will eliminate any potential back-and-forth delays.
How Long Does It Take to Get Credentialed with Blue Cross Blue Shield?
Usually, Blue Cross Blue Shield takes 90–120 days to credential a new provider.
Why does it take so long? This company has the most extensive verification in the business, checking all your education, residency, malpractice, and current license history.
If you are joining a group practice with an active BCBS contract, your onboarding may take as little as 60 days. First-time solo applicants should expect the full 3–4 months. Possible reasons for a hold-up:
- Missing documents in CAQH
- Incorrect taxonomy codes
- Mismatched NPI or license numbers
- Outdated malpractice coverage
The only way to stay on schedule is to send your documents clean and complete.
How Long Does Credentialing Take for Nurse Practitioners?
The typical timeline for Nurse Practitioners is 90–150 days, and even though they are licensed clinicians, many payers still do a more detailed review. If you are a newly graduated NP, or recently obtained a new state license, expect more verification, especially in states with more restrictive NP licensure laws.
Below is a sample NP credentialing timeline.
- Verifying state licenses: 1–2 weeks
- Setting up CAQH and attesting: 2–3 weeks
- Submitting applications to insurance payers: 4–6 weeks
- Payer reviewing and contracting: 4–8 weeks
To smooth this out, ensure that the details of your supervising physician (if required in your state) are clean and current. Not doing this is the most common cause of delayed NP applications.
How long does it take to get credentialed with medicaid?
Medicaid credentialing takes 60 to 120 days generally, but it does depend on the state.
Since each state runs its own medicaid program, the credentialing requirements also differ. Some states provide services in six weeks or less, while others take four months or more.
The state workload, backlog, and the accuracy of the documents you submit, individual or group provider status and the background check clearance impact the timing.
For instance, medicaid credentialing takes about 90 days in Texas and often wraps up in 60 days in Florida, if documents are in order.
The Good part is, once you are credentialed with medicaid, revalidation is only required every 3-5 years rather than every year.
How long does Medicare take to credential you? Here’s an answer.
For most cases, the wait is about 60 to 90 days, but for complex applications, it can take 120 days.
When it comes to application management, the Center for Medicare & Medicaid Services (CMS) assigns applications to PECOS (Provider Enrollment, Chain, and Ownership System) division. PECOS has errors and missing data that result in delays.
In Medicare credentialing, you:
- Fill out and submit the CMS-855I or 855B form on PECOS.
- Wait for the Medicare Administrative Contractor (MAC) to review it.
- Respond if they ask for more documents.
- Get your approval letter and your Provider Transaction Number (PTAN).
- Insider tip on expediting your application.
If you are reassigning benefits with a group that has an existing contract with Medicare, the approval can take 30-45 days, instead of the 60-90 days.
What determines how long it takes to get an Insurance Credentialing?
- The most apparent factor is the amount of documents to be processed. During the peak season, the approval delay is inevitable.
- Then there are incomplete applications, there are missing documents that take backwards the review.
- Old and incorrect CAQH profiles, sets of data that result in denial, especially when they are outdated.
- Credentialing with multiple payers is also a big factor, credentialing with 8 insurers takes 2-3 times longer than with 1.
- State-specific laws are also a factor. Rules around Medicare and NPs scope of practice are inconsistent.
- If there are prior disciplinary actions, they are also slower to verify.
- Credentialing is a long process but knowing these factors helps you stay realistic with your planning and avoid cash flow gaps.
How to Speed Up the Credentialing Process
While you can’t control the payer’s timeline, you can control your own readiness.
1. Keep CAQH updated
Remember to report any changes to your license, malpractice info, and attestations every 120 days.
2. Submit complete applications
After every form is filled out, be sure to double check the name, NPI, address, license number, and other personal info to ensure everything is complete.
3. Follow up weekly
Inactivity can be stressful. Every 7-10 days, you should call or email your payer representative for a status update.
4. Organizing documentation in one site
It is a good idea to prepare a credentialing folder that contains everything you are required to submit and all supporting documents that are needed.
5. Think about outsourcing credentialing
If the management of payer follow-ups seems to take up all your time, credentialing outsourcing can assist in getting credentialed quicker.
The Real Cost of Delayed Credentialing
Any days a provider isn’t credentialed is a day they can’t bill for insured patients. For an average practice, that amounts to $500 to $1,000 per day of unearned income.
When things get delayed, it’s not just lost income, it’s lost patient trust, lost trust, scattered schedules, and messy billing. That’s why an experienced credentialing partner is not an expense, but an investment to keep your operations steady and profitable.
Already having your insurance credentialing will help keep your practice open. It may not come in quickly, but it will give you stability. Knowing the projected time-frames and spanning from Blue Cross to Medicaid and Medicare will help you gauge your start date, project your cash flow, and break the billing stalled cycle.
Want something that will save the back and forth paperwork and time? A2Z Billings will take care of your credentialing process. Completed and on-time and you will keep your focus, patient care, not paperwork.
FAQs About Insurance Credentialing
- What happens if I start seeing patients before credentialing is complete?
You can see patients, but you will not be able to bill insurance for those visits until approval. Some practices use a “hold billing” policy until the provider’s credentialing is finalized.
- Can credentialing be expedited?
Most payers don’t officially offer rush processing, but submitting complete documentation will help expedite things.
- How often do I need to re-credential?
Typically every 2–3 years, depending on the payer. Re-credentialing ensures your data and licenses are current.
- Can I transfer my credentials to another state?
No. Credentialing is payer- and state-specific. If you move, you’ll need to reapply with each insurer in the new state.
- Do group practices get credentialed faster?
Sometimes. Payers often prioritize group applications with existing contracts since their information is already in the system.
- What’s the difference between credentialing and enrollment?
Credentialing verifies your qualifications; enrollment establishes your contract and ability to bill payers.
- Who handles credentialing – the provider or the practice manager?
Either can do it, but many practices delegate it to credentialing specialists or third-party billing companies.
- What is CAQH attestation?
It’s a quarterly confirmation that your CAQH information is accurate and up to date. Missing attestations delay payer verifications.
- Can credentialing be done before getting a state license?
No. Licensure is a prerequisite – you must be licensed before starting credentialing.
- What’s the fastest credentialing timeline possible?
The shortest realistic timeline is 45–60 days, achievable only if all documents are correct and payers have no backlog.