Credentialing Mistakes That Could Cost Your Practice

Incomplete Application Submissions

One of the most common credentialing mistakes healthcare providers make is submitting incomplete applications. Missing documents or information can delay the credentialing process by weeks or even months. Always double-check that you've included:

• Current medical licenses
• Board certification documents
• Malpractice insurance certificates
• Complete work history with no gaps
• References from peers

Failing to Track Expiration Dates

Medical credentials aren't permanent - they require regular renewal. Many practices lose revenue when providers suddenly become ineligible to bill insurers because someone forgot to track:

• State medical license renewals
• DEA registration expiration
• Board certification maintenance
• Malpractice policy renewals

Not Verifying Insurance Participation

Assuming you're credentialed with all major payers in your area is a costly mistake. Each insurance plan requires separate credentialing, even within the same payer. Before seeing patients, verify:

• Your NPI is active with each payer
• Your tax ID is properly linked
• Your specialty is correctly listed
• All locations where you practice are included

Poor Documentation Management

Disorganized credentialing files create problems during audits and renewals. Implement a system to:

• Store digital copies of all documents
• Track submission dates and responses
• Note specific requirements for each payer
• Maintain a calendar of renewal deadlines

Ignoring Credentialing for New Services

Adding new services or procedures often requires additional credentialing. Before offering new treatments, check whether you need to:

• Update your specialty designations
• Submit additional certifications
• Obtain facility accreditation
• Complete payer-specific requirements

Best Practices for Smooth Credentialing

To avoid these common mistakes, consider implementing these credentialing best practices:

1. Start the process at least 90-120 days before you need privileges
2. Create checklists for each payer's requirements
3. Use credentialing software to track deadlines
4. Designate a staff member to oversee the process
5. Conduct quarterly credentialing audits

By avoiding these common credentialing mistakes, you'll ensure your practice gets paid promptly and maintains compliance with all regulatory requirements.