The Hidden Cost of Delayed Credentialing: What You’re Losing If You Go It Alone

For many healthcare providers, credentialing feels like just another bureaucratic hurdle—an unavoidable step between setting up a practice and getting paid. However, a slow or mishandled credentialing process can result in significant lost revenue, denied claims, and wasted time.

If you attempt to manage credentialing yourself without understanding the potential pitfalls, you might be losing thousands of dollars without even realizing it.

Let’s explore what’s at stake when credentialing isn’t handled correctly—and why getting it right from the start is one of the smartest financial moves you can make.

Every Day You’re Not Credentialed Equals Revenue You May Never Recover

Credentialing Delays Mean Immediate Lost Income

If you can’t bill insurance, you can’t get paid. But how much is that actually costing you? The financial impact of delayed credentialing depends on:

• Your specialty (some providers bill higher than others)
• Your payor mix (Medicare, Medicaid, and private insurers all reimburse differently)
• Your patient volume (new providers often start with fewer patients but grow over time)
• Whether payors allow retroactive billing (some do, but only under strict conditions)

Let’s break it down with realistic examples for two different practice types.

Example 1: A Primary Care Provider Opening a Practice

A family medicine doctor is starting their new private practice. They expect to see 15 patients per day, five days a week (75 visits per week). Their reimbursement per visit varies based on payor:

• Medicare: $92 per visit (CMS national average for an outpatient office visit)
• Medicaid: $60 per visit (varies by state)
• Commercial insurance: $120 per visit (higher rates but varies widely)

In this case, their blended average reimbursement is:

(40% Medicare x $92) + (30% Medicaid x $60) + (30% Commercial x $120) = $92.80 per visit

If credentialing takes three months (12 weeks):

• 75 visits per week x 12 weeks = 900 total visits
• 900 visits x $92.80 per visit = $83,520 in lost billable revenue

Retroactive Billing Considerations:

• Medicare allows retroactive billing for up to 30 days prior to application approval.
• Private insurers typically do not allow retroactive billing, meaning those losses are permanent.
• If 50% of patients were covered by payors that allow retroactive billing, the provider might recover up to $41,760, but the rest is gone.

Example 2: A Solo Mental Health Provider Starting a Practice

A Licensed Clinical Social Worker (LCSW) launching their own practice expects to see six clients per day, four days per week (24 sessions per week). Their average reimbursement per session varies by payor:

• Medicare: $82 per session
• Medicaid: $55 per session
• Commercial insurance: $100 per session

Since behavioral health practices often rely heavily on private insurance and Medicaid, let’s assume this payor mix:

• 20% Medicare at $82 per session
• 50% Medicaid at $55 per session
• 30% Commercial insurance at $100 per session

This results in a blended average reimbursement of $70.60 per session.

If credentialing takes three months (12 weeks):

• 24 sessions per week x 12 weeks = 288 total sessions
• 288 sessions x $70.60 per session = $20,332 in lost billable revenue

Retroactive Billing Considerations:

• Medicare may allow retroactive billing for up to 30 days, but Medicaid and private insurers often do not.
• If only 20% of the provider’s patients were Medicare beneficiaries, they might recover $3,936—but the rest is permanently lost.

What This Means for Your Practice

• Even a one-month delay in credentialing can mean thousands in lost income, and longer delays can cripple a small practice before it even gets off the ground.
• Retroactive billing may help in limited cases, but it won’t recover everything—and it’s not guaranteed.
• Whether you’re an independent provider or part of a larger practice, credentialing delays are one of the most financially damaging mistakes you can make.

You’re Not Just Losing Money—You’re Losing Time

The DIY Credentialing Trap

Some providers believe they can save money by handling credentialing themselves.

But credentialing is not just filling out forms—it’s a complex, multi-step process involving:

• Verifying licenses, certifications, and work history.
• Completing applications for each individual payor.
• Navigating rejections, corrections, and resubmissions.
• Coordinating with multiple insurance companies.
• Monitoring revalidations to avoid lapses.

Even experienced credentialing professionals spend hours per week managing this process.

If you’re dedicating your time to credentialing instead of patient care or growing your practice, consider the true value of your time.

Small Mistakes Can Cause Big Delays

The High Cost of Errors

Credentialing applications must be accurate. If there’s a mismatch in your business name, National Provider Identifier (NPI), address, or licensing information, payors will reject the application—forcing you to start over.

Every resubmission means:

• Additional weeks-long delays in processing.
• More unpaid services while you wait.
• Increased frustration and wasted administrative time.

Payors aren’t in a rush to expedite your application—each mistake pushes your enrollment further down the queue.

Avoiding simple mistakes like inconsistencies in your documentation, missing signatures, or incorrect provider information can mean the difference between a smooth process and months of waiting.

Credentialing Mistakes Can Impact Future Revenue

What Happens If You’re Not Revalidated on Time?

Credentialing isn’t a one-and-done process—most insurance payors require regular revalidations.

If you miss a revalidation deadline:

• Your payor contract could be terminated.
• You might have to reapply from scratch—causing months of lost revenue.
• Your claims could be denied—even if you were previously credentialed.

The worst part? Most providers don’t realize their revalidation is overdue until their payments stop.

Tracking revalidations and keeping up with credentialing is just as important as the initial enrollment—but it’s often overlooked until it’s too late.

Can You Afford to Get Credentialing Wrong?

Credentialing isn’t just a paperwork process—it’s the key to getting paid for the work you do.

If you’re waiting on payor approvals, chasing down paperwork, or struggling with denied claims, it’s time to rethink your approach.

The cost of delayed credentialing isn’t just frustration—it’s real dollars out of your pocket.

Make sure you’re not leaving money on the table.

If you need assistance with your credentialing process, schedule a consultation with pie Health to ensure a smooth and efficient experience.