Credentialing and provider enrollment are make-or-break steps for driving revenue growth in healthcare organizations. Since credentialing starts physician onboarding and enrollment initiates the revenue cycle, it is essential for healthcare organizations to make these processes as efficient as possible.
Though closely linked, credentialing and enrollment are not the same, and understanding their differences is key. Provider credentialing verifies a provider’s qualifications to ensure they meet standards for care while provider enrollment registers the provider with insurers so they can bill for services.
Success hinges on having the right team and resources, whether in-house or third-party, to support both functions.
In a recent Becker’s-hosted webinar, more than 150 credentialing and enrollment leaders from hospitals and non-acute care organizations were polled on their biggest challenge with credentialing and enrollment today. The resounding response? Lengthy timelines that slow down revenue capture.
Of the attendees, 54% said lengthy credentialing timelines was their biggest challenge, followed by 29% who said lack of automation or inefficient processes, 15% who said insufficient staffing to manage workload, and 2% who said compliance risks due to difficulties in maintaining up-to-date provider information.
Organizations like Northwell Health and Hebrew SeniorLife, who spoke during the webinar, are grappling with issues such as inefficient data coordination, a lack of automation, and the operational complexity that comes with mergers, acquisitions, and provider expansion. Delays in onboarding providers affect cash flow, patient access, and operational efficiency—all areas that cannot afford to be hindered.
Health systems are looking for every feasible way to drive efficiency and revenue impact, especially as hospital operating margins are predicted to stay low in 2025, according to Moody’s.
This sentiment was echoed by the webinar attendees when asked about their organization’s top priority for credentialing and provider enrollment in 2025. Fifty two percent said accelerating provider onboarding and enrollment timelines was their biggest priority in the coming year, followed by 23% who said improving collaboration between credentialing, enrollment, revenue cycle and other internal teams, 19% who said implementing or upgrading technology for automation, and 5% who said enhancing data analytics to measure and optimize performance.
By speeding up the time it takes to get providers credentialed and enrolled, the sooner providers can start seeing patients and generating revenue.
It is no secret that process improvement is top of mind for acute and non-acute organizations alike. Two standout strategies emerged during the webinar discussion.
First, Hebrew SeniorLife’s alignment of credentialing with Quality Assurance and Performance Improvement (QAPI) frameworks required by CMS is a model worth replicating. By using this approach, they’ve been able to reduce credentialing timelines by as much as 22 days. Second, Northwell Health’s “data hub” approach stood out as a best practice.
Centralizing provider data into one system has allowed them to improve reporting, reduce bottlenecks, and eliminate redundant provider touchpoints—all of which contribute to faster provider onboarding.
As Alex Baglivi, Assistant VP of Provider Enrollment from Northwell Health explained, enrollment is not just an operational task—it is a “top-of-funnel” activity for the revenue cycle. When enrollment teams are embedded within the revenue cycle team, health systems gain visibility into critical metrics like first-time denials and cash flow impact.
This alignment also allows enrollment teams to quickly course-correct when issues arise, leading to better financial predictability and stronger payer relationships. It is a structural shift that’s driving meaningful results.
While the promise of AI is exciting, panelists were quick to highlight that it is not a cure-all. Baglivi shared that while robotic process automation (RPA) can streamline rote data tasks like pulling information from payer portals, the nuanced decision-making required in credentialing still requires human oversight.
Alexandra Mayville, Manager of Department of Medicine for Hebrew SeniorLife, reminded everyone that AI must be deployed thoughtfully with a focus on patient safety and accuracy. There is no doubt that AI will play a larger role in our industry, but it’s clear we’ll need to balance automation with human expertise.
The challenges that come with organizational growth means leaders often turn to third-party resources, like a Credentialing Verification Organization (CVO), to help with spikes in credentialing applications and tackle backlogs.
However, it is important to understand what defines success when selecting a CVO partner. As Mayville pointed out, the success of an outsourcing relationship depends on ensuring alignment between your internal standards and the CVO’s processes. While outsourcing can streamline operations and reduce the internal workload, it is essential to maintain control of key processes and provider relationships.
After facing internal staffing challenges, Hebrew SeniorLife opted to partner with symplr for CVO services. The result? A significant reduction in credentialing cycle times and access to a broader pool of expertise.
To hear how you can improve your credentialing and enrollment operations, watch the full webinar, “How Effective Provider Enrollment Fuels the Revenue Cycle.”
