6 Medical Credentialing Tips to Improve Your Practice Revenues

medical credentialing

Do you want to ensure that every dollar billed is collected? The first step to getting paid for your service is ensuring timely medical credentialing and payor enrolment for all your providers.

Lapses in credentialing and payor enrolment will create delays in appointment scheduling, impact the patient’s experience in dealing with your medical practice, and lead to wasted administrative efforts in following up on unpaid claims.

If the medical credentialing processes are not up to the mark, your medical practice’s revenue collections will be significantly lower than expected.

So, how does one ace the medical credentialing game?

Medical credentialing for a provider can take up to 120 days. You can streamline the process to ensure that you waste minimal time waiting for your team of physicians to be approved by payers.

6 Medical Credentialing Tips for Every Medical Practice

Here’s what you must do to improve medical credentialing outcomes for new and existing providers:

  1. Please complete the entire credential profile form. All blanks need to be filled in.

The main reasons for new provider credentialing to fail are incomplete work history and failure to explain time-lapses of more than 30 days. The CV of the provider should mention the last position held and the end date. Updated licenses, Insurance Liability certificates, and DEA certificates must be mentioned.

  1. Sometimes less than three references have been given on the form or are not provided. If three references are required, submit at least five references.
  2. Payors receive an influx of credentialing requests in the months following graduation. So don’t wait until the summer months to apply, as you will probably experience delays.
  3. Update the provider’s CAQH profile information once a month or at least once every two months. The CAQH portal eliminates the paperwork involved in credentialing with multiple payers.
  4. Proactively monitor the credentialing revalidation dates and ensure the requests are submitted well beforehand.
  5. Just like medical coding and billing, medical credentialing also can be effectively outsourced. When you outsource medical credentialing, your credentialing work is managed by a team of experts who will track revisions in payer regulations and have access to the best credentialing software. Outsourcing medical credentialing will ensure that your provider credentialing remains up to date and that your providers can attend to patients without worrying about claim denials.

If PracticeForces is handling your credentialing, then ensure that all your latest documents are sent to us via email at (credentialing@practiceforces.com). Any credential form or information request sent by us should be responded to the same day or within two days at the latest.

From a patient perspective, if a provider is non-participating with a payer or product, ensure that your front office does not schedule patient appointments for that payer or product until the physician’s credentialing issue is resolved.

Understanding how medical credentialing works can make a significant difference to the revenues of your medical practice. An inefficient credentialing system can impact your cash flow and prove expensive in the long run.

Contact us to learn more about improving medical credentialing outcomes for your healthcare enterprise.


Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

Related Posts


Do you want to streamline your reimbursements?

Subscribe for actionable tips and insights to grow your medical practice >

Call Now Button