Credentialing with insurance companies is one of those processes where timing matters as much as accuracy. And every year, practices underestimate how long insurance credentialing actually takes. There’s an old saying: “The best time to plant a tree was 20 years ago. The second best time is now.” Insurance credentialing works the same way. The earlier you prepare, the more predictable your timeline becomes. January is always the slowest time of year. Payors face holiday backlogs, credentialing committees meet less often, and new provider applications surge. Commercial insurance credentialing slows down, Medicare enrollment hits capacity, and several Medicaid programs fall behind federal timeliness standards. If your practice plans to hire or expand in early 2026, starting credentialing early is the difference between getting paid on time and waiting months for approvals. Most delays begin long before a payor ever reviews an application. This guide breaks down what credentialing timelines look like in 2026 based on industry data, how Medicare and Medicaid enrollment affect commercial plans, and what practices can do to stay ahead.
Start with Medicare
Medicare enrollment should almost always come first. Commercial plans often rely on PECOS data to verify provider information, and some won’t finalize contracting without a Medicare PTAN. If PECOS and CAQH profiles don’t align, commercial credentialing may pause or restart. CMS publishes clear processing expectations. PECOS electronic submissions without site visits typically process in about 15 days, and 95% fall within that window. When a site visit or additional development is required, processing can take up to 50 days. Paper submissions take 30 to 65 days. For a new clinician joining a behavioral health group or a PT clinic adding staff, completing Medicare early provides a clean foundation for the rest of insurance credentialing.
Here’s what this looks like in real life.
A therapist is scheduled to start on March 1, 2026. The practice submits a PECOS Medicare application on January 5. PECOS approves the enrollment on January 22, well within the standard electronic timeline. With Medicare active, the practice submits commercial applications on January 24. Those payors automatically pull the updated PECOS data, avoiding address mismatches and taxonomy discrepancies. CAQH is already fully complete and attested on January 20, so commercial plans move directly into the review cycle. Most commercial payors take 60–120 days. That means approvals begin arriving between March 25 and May 23. Because Medicare was completed first, the therapist can bill Medicare from March 1, and commercial plans fall into place shortly after. Starting with Medicare keeps the entire timeline moving instead of forcing commercial plans to wait or restart.
Medicaid requires early planning too
Medicaid enrollment doesn’t anchor commercial plans, but it remains the least predictable. Federal rules require processing within 45 to 90 days, yet many states regularly miss these standards. CMS reporting shows 16 states with months where more than 10% of applications were late, and several states have had significantly higher delays. Practices that rely heavily on Medicaid—particularly behavioral health, pediatrics, and primary care—should start early and be prepared for state-specific documentation requirements that add time to the process.
Here’s how Medicaid timing can play out in practice.
A behavioral health group in California hires a provider who will start on April 1, 2026. Knowing Medicaid can be unpredictable even when the state meets federal timeliness standards, the practice submits the provider’s Medicaid enrollment on January 10. California typically processes within the 45-day window, but application volumes rise early in the year. On February 12, the state requests additional documentation—common for behavioral health licenses, practice locations, or supervising physician details. The group responds immediately, but the extra development adds another 20 days. Final approval doesn’t arrive until March 28, just days before the provider’s first scheduled patients. Had the practice waited until February to submit, approval likely would have landed in late April or May, delaying the ability to bill Medicaid and forcing the practice to reschedule or write off early visits.
Commercial insurance credentialing
Commercial payors generally process within 45 to 120 days, but variation across states, plans, and specialties remains high. Closed networks, outdated CAQH profiles, mismatched addresses, and incomplete documentation are among the most common causes of delays. MGMA reports that more than half of practices saw credentialing-related denials rise due to data discrepancies or prolonged processing. A single mismatch between a Type 2 NPI address and a provider’s profile can hold a file for weeks and lead to a full restart.
Typical Commercial Payor Credentialing Timelines
While timelines vary by state and specialty, the following ranges reflect common processing windows reported by national plans:
• Blue Cross Blue Shield: 60–120 days
• Aetna: 60–90 days
• UnitedHealthcare: 30–120 days depending on state
• Cigna: 45–90 days
These ranges don’t account for delays caused by closed panels, missing CAQH elements, address mismatches, or committee deferrals, which can significantly extend processing times.
Delegated networks (Optum, Carelon, and others)
Some commercial plans outsource the credentialing review to delegated entities such as Optum or Carelon. These organizations often operate on fixed monthly or quarterly cycles, require deeper file reviews, and do not usually process corrections mid-cycle. As a result, delegated networks can take as long—or longer—than the traditional commercial plans listed above, especially in competitive or densely populated markets.
Tighter verification standards in 2026
NCQA changes effective July 2025 require more frequent monitoring and shorter verification windows. License checks must now occur monthly, exclusion checks every 30 days, and credentialing windows have been reduced to 90 to 120 days. These tighter rules create less tolerance for outdated CAQH data, old contact information, mismatched taxonomy codes, or inconsistent documents. A small discrepancy can cause a full restart instead of a simple correction.
The financial stakes
The American Hospital Association reports that organizations spend nearly $20 billion annually appealing denied claims. Commercial plans deny around 15% of claims on first submission, and Medicare Advantage denies closer to 16%. More than 60% of prior authorization denials are overturned on appeal. For small and mid-sized practices, credentialing delays translate directly into lost revenue. Merritt Hawkins reports that physicians generate between $2.38 million and $3.7 million per year for their organizations. Every week a provider is unable to bill affects financial performance, not just scheduling.
What practices can control
The largest preventable delays come from inconsistent setup, not payor behavior. Practices often ask questions such as: “Why did the payor say our address doesn’t match?”, “Why is CAQH verified but still marked incomplete?”, and “Why is Medicaid requesting documents we already submitted?” In most cases, the underlying data does not align across NPI records, CAQH, licenses, and internal systems. Standardizing information early—before applications go out—is the most reliable way to reduce credentialing timelines.
What practices cannot control
No practice can change payor review cycles. Commercial plans, Medicaid programs, MACs, and delegated networks follow fixed schedules. January through March is consistently the slowest time of year. Even perfect files cannot jump the line.
Preparing for 2026
If you are preparing for growth or adding providers, this is a good time to review your structure. Update CAQH completely, confirm NPI alignment, ensure all addresses and taxonomy codes match, gather renewed licenses and documents, and identify any payors that allow retroactive billing. Most delays can be avoided when the setup is handled correctly from the start.
For practices that want help evaluating their credentialing structure or planning their 2026 enrollments, the pie team offers credentialing consultations. These sessions focus on reviewing your setup, identifying risk points, and outlining a realistic timeline based on your state, specialty, and payor mix.
Final note
Insurance credentialing in 2026 will still require patience, accuracy, and early preparation. But when your data is consistent and your process is structured, credentialing becomes far more predictable. pie is here as a resource for practices that want clarity on the right credentialing structure for the year ahead.
