In many practices, credentialing started small. An office manager handled payer enrollment. A billing lead tracked reappointments. Someone kept a spreadsheet. That worked when payer rules were simpler and provider panels didn’t change much.
That’s no longer the case.
Practice leaders consistently report rising regulatory and payer demands. According to MGMA’s Annual Regulatory Burden Report, nearly 9 out of 10 medical group leaders say administrative requirements have increased in recent years. The American Medical Association’s research on physician administrative burden and burnout shows clinicians continue to spend significant time on paperwork and payer-related work.
The CAQH 2024 Index estimates that tens of billions of dollars are spent each year on administrative transactions, with providers carrying most of that load.
At some point, credentialing stops being “something we handle” and becomes a business decision. Do you build a formal internal process with dedicated time and accountability? Or is it time to outsource credentialing to a team whose only job is managing payer enrollment and revalidation, like credentialing services for medical practices?
These pressures affect behavioral health groups, therapy practices, optometry clinics, physical therapy organizations, specialty practices, and multi-location provider groups alike. This is not just a physician issue.
The shift usually shows up in patterns. If you recognize more than one of the following, credentialing may have outgrown your current setup.
Sign 1: You Hear About Payer Problems From Patients First
One of the clearest signs it may be time to outsource credentialing is when you learn about network or enrollment issues from patients before anyone on your team does.
What that looks like:
• A patient says you’re no longer in network
• Claims are denied because a provider is “not on file”
• A payer directory shows the wrong status
• A reappointment deadline was missed
MGMA’s 2025 credentialing and reappointment crunch poll found that about one third of medical groups report some level of credentialing or reappointment backlog.
KFF’s analysis of ACA marketplace claims denials found in-network denial rates averaged 19 percent in 2023. Enrollment discrepancies are one of the recurring technical drivers of those denials.
When no one is actively monitoring enrollment status, the first sign of trouble is often a denied claim or a patient call. By that point, revenue is already delayed.
Credentialing happens before billing. When it slips, you feel it later.
Sign 2: Your Highest-Paid People Are Doing Administrative Work
Another strong signal that you may need to outsource credentialing is how much senior time is tied up in it.
A 2024 Google Cloud and Harris Poll study estimated clinicians spend roughly 28 hours per week on administrative work.
CAQH’s administrative cost analysis shows providers carry most of the transaction cost burden in healthcare administration.
MGMA’s reporting on prior authorization shows that most practices have reassigned or hired staff just to keep up with payer requirements. Credentialing has many of the same characteristics: plan-specific rules, portal submissions, follow-up calls, document uploads, and reappointments.
If physicians, therapists, nurse practitioners, or practice owners are logging into payer portals to chase enrollment status, that’s not a small issue.
If you are tracking enrollment in spreadsheets, it’s worth reviewing the hidden cost of credentialing spreadsheets. Manual systems often hide how much time is actually being spent.
Run the math. If a senior clinician spends even a few hours per week on credentialing issues, that adds up quickly over a year.
This is not about blame. It is about structure. If the people with the highest impact in your organization are spending time on enrollment follow-ups, the process likely needs to change.
Sign 3: New Hires Take 90–180 Days to Become Fully In Network
Growth plans assume productivity. Payer timelines often don’t cooperate.
MGMA polling on credentialing backlogs suggests delays are common across practice settings.
HFMA’s reporting on revenue cycle staffing challenges notes that staffing shortages make it harder to stay ahead of administrative requirements.
When a new clinician, therapist, or specialty provider joins your practice, they may be clinically ready within weeks. Payer approval is a different timeline.
If your pro forma assumes full in-network participation within 30 to 60 days, but approvals take 90 to 180 days, the numbers don’t match reality.
If you want a deeper breakdown of insurance credentialing timelines in 2026, it’s worth reviewing current benchmarks before finalizing hiring projections.
This is often the moment leaders start seriously asking whether to outsource credentialing rather than continue managing delays internally.
Sign 4: You Only Learn About Rule Changes When Claims Get Denied
Payer rules change. Forms change. Revalidation cycles change. Directory attestation requirements change.
MGMA’s stress and leadership polling shows practice leaders feeling pressure from constant external changes.
HFMA’s coverage of ACA marketplace denial trends highlights how denial patterns can directly affect financial stability.
KFF’s review of marketplace claims denial data underscores how little visibility providers often have into payer decision logic.
If your team finds out about rule changes only after claims are denied or letters arrive, the process is reactive.
If there is no centralized view of enrollment status, expirations, and payer communications, implementing a credentialing dashboard and enrollment tracking system can bring clarity.
You should not be surprised by your own enrollment status.
Should You Build In-House or Outsource Credentialing?
This is not about pride. It is about capacity.
Ask yourself:
• How often do payer issues surface through denials?
• How long does it take new providers to become fully in network?
• How many senior hours are spent each week on credentialing issues?
• How often do reappointments or roster updates create last-minute problems?
If you are considering outside help, this guide on how to evaluate a credentialing vendor walks through what to look for.
When Outsourcing Credentialing Becomes a Practical Step
Outsourcing credentialing is not dramatic. It is often a practical decision made after repeated delays, denied claims, or hiring timelines that do not line up with payer reality.
Administrative burden is not decreasing. Denials remain a measurable issue. Staffing constraints are real.
If you are evaluating whether to outsource credentialing, start by reviewing your numbers. How long are approvals taking? How many hours are being spent? How often are denials tied to enrollment?
If you would like an objective review of your current process, you can request a free credentialing consultation.
