Bringing credentialing in house

Why this page exists

Search for how a billing company adds credentialing and every result is a credentialing company offering to do it for you. That is a fair business, and for plenty of firms it is the right answer. It does mean there is almost nothing written from the other side, for the owner deciding whether the work is worth holding.

The market rate is public: services advertise roughly $150 to $300 per provider per payer. What that is worth against doing it yourself depends on your book, your people and your time, and I am not going to pretend to know any of the three. What I can set out is the work.

What the work actually is

Six standing jobs per provider, running at once and on unrelated timetables. The dates behind them are mapped in what expires, and when.

1. Getting a provider approved, per payer

   Roughly 25 payers for a typical provider, each with its own portal, its own forms, and its own idea of what the same document is called. The estimate is ours and it moves with specialty, state, and how many plans a practice takes.

2. Keeping the profile attested

   CAQH re-attestation every 120 days, and every 180 in Illinois. Miss it and applications already in flight can stall with nobody told.

3. Re-credentialing, forever

   At least every 36 months per payer, on the date that payer last approved that provider. Not one date per provider. One per provider per payer.

4. Watching the documents underneath

   State license on each board’s own cycle, DEA every three years and per state of practice, malpractice on the policy’s term. All primary-source verified again at re-credentialing.

5. Screening the roster monthly

   Against OIG-LEIE, SAM.gov and the state lists. Nothing expires here, which is exactly why it falls off a calendar built for renewals.

6. Answering the payer when it checks

   Plans must verify directory records on a 90-day cycle. A record they cannot verify can be flagged as unverified in the public directory, so not answering has a cost even though the legal duty is theirs.

The part that surprises people is not any single job. It is that a firm with twenty providers is running all six against every one of them, on dates that never align, across client practices that each think of their own doctors as the whole list.

What people actually complain about

Read the public reviews of outsourced credentialing services and the complaint is rarely price. It is responsiveness, staff turnover, and errors that follow from work changing hands: enrollments still not contracted after a long wait, repeated mistakes that cost the practice its providers’ confidence, and reps who go quiet at the point the work matters.

That pattern is worth naming plainly because it decides the question. If what is wrong is the service rather than the arrangement, changing vendor may fix it and nothing here applies. If what is wrong is that nobody outside your firm has a reason to care about your clients’ deadlines as much as you do, that is structural, and no vendor change addresses it.

I am not going to quote those reviewers here. They wrote about somebody else’s product, and dressing another company’s unhappy customers up as evidence for mine would be exactly the kind of borrowed proof this site does not use.

When the answer is to keep outsourcing

Three cases, and they are not rare.

• You are happy with your service. The complaint that drives most of these conversations is responsiveness, not price. If yours answers, there is no problem here to solve.
• Your book is small enough that the per-provider rate is cheaper than an hour of anyone’s week. At a handful of providers, outsourcing wins on arithmetic and it is not close.
• You want somebody else to carry the verification responsibility. A credentials verification organization takes on work and accountability that a piece of software does not. If that transfer is the thing you are buying, keep buying it.

What software changes, and what it does not

Bringing this in house means holding the dates. That is the job software is genuinely good at, and it is what RosterSafe does: every clock above, for every provider, across every client practice, on one timeline, with notice before anything passes.

It does not fill in a payer portal, does not attest for you, does not chase an enrollment, and does not take on the verification responsibility a service would. The filing stays yours. We are deliberately not a credentials verification organization, which is the same reason the firm keeps the client relationship and the margin.

If you are weighing this decision, the honest framing is that software removes the tracking problem and leaves the doing. Whether the doing is worth holding is the part only you can answer.

Put your roster on a timeline