Credentialing Backlog

The accumulation of unprocessed credentialing applications at a payer or facility, resulting in extended processing times beyond normal timelines.

A credentialing backlog happens when a payer receives more applications than their credentialing department can process in a normal timeframe. During backlogs, applications that would normally take 60 to 90 days can take 120, 150, or even 180 days. Backlogs happen for several reasons. Payers may be dealing with staff turnover in their credentialing department. A large health system might dump 50 provider applications at once when they acquire a new practice group. End of year tends to be busier as new graduates complete training and enter practice. Medicare experiences backlogs when CMS issues revalidation waves to large numbers of providers simultaneously. The financial impact of a backlog is significant. Every day your application sits unprocessed is a day you cannot bill that payer. If a 30-day backlog delays your enrollment, and you see 20 patients per day at an average of $150 per visit, that is $90,000 in unbillable revenue. You cannot control the backlog, but you can minimize its impact. Submit your applications as early as possible, ideally 120 days before you want to start seeing patients. Make sure your application is complete the first time so it does not get sent back for corrections, which puts you at the back of the line. Follow up weekly once your application has been in process for more than 30 days. Some payers offer expedited processing for certain situations: providers joining underserved areas, providers replacing a departing provider, or providers needed for network adequacy. Ask about expedited processing when you submit your application. Delegated credentialing can bypass the backlog entirely. If you are joining a group that has delegated credentialing authority with the payer, your credentialing happens through the group, not through the payer's backed-up queue.