• November 6, 2026
• | Credentialing

Provider credentialing can be challenging for any healthcare organization. However, smaller medical practices that deliver a large share of U.S. healthcare (47% of physicians worked in practices with 10 or fewer physicians in 2024) face a unique set of obstacles compared with their larger counterparts. Hospitals and health systems typically have credentialing and enrollment departments and access to more resources — smaller practices usually don’t. That means the work falls to whoever has time, and more often than not that’s an office or billing manager, a practice administrator, or even the provider.

This can be a problem for two reasons. First, it pulls people away from their expertise and the jobs they were hired to do. Second, credentialing and payer enrollment are complex enough that mistakes lead to costly delays and keep providers from seeing patients. Every day a provider can’t see patients is a day of disrupted care. The good news is that there are solutions for small practices looking for more effective ways to credential providers.

Why credentialing gets complicated fast

It’s important to first understand where the challenges can hide. A lot of it comes down to how informed the person in charge of the practice’s credentialing process is. Requirements also change with the type of medical practice. For example, a family physician who opens an urgent care center may need a CLIA certificate to perform lab work, which a standard doctor’s office doesn’t require.

That means extra documentation and certifications are needed on top of enrolling the group with payers like Medicare and Medicaid, which have their own sets of guidelines. Medicaid requirements vary state by state, and keeping CAQH profiles current is its own ongoing task. Every payer works differently, and requirements change constantly.

The time adds up. In a CAQH survey of 1,240 physician practices, those practices with fewer than five providers spent an average of $319.46 a month keeping health plan directory information current. That is about $3,800 a year. Across all practice sizes, the typical practice spent the equivalent of one full staff day per week on that work alone.

Credentialing is never a one-time task

Follow-up and maintenance are critical parts of provider credentialing. For practices that rely on staff with other responsibilities to also manage credentialing, things can be missed. Applications can slip and timelines can lapse, all of which keeps providers from seeing patients.

The clock never stops. CAQH requires providers to re-attest every 120 days, which is at least three times a year per provider. A five-provider practice has about 15 attestations a year to track. Medicare adds its own cycle. Enrolled providers revalidate roughly every five years, and Medicare deactivates enrollment if no revalidation is submitted.

Credentialing requires ongoing maintenance and follow-up to keep providers compliant and in network with payers, including:

• Tracking documentation and responding to payer requests for more information
• Monitoring recredentialing dates
• Watching for license expirations
• Keeping providers compliant and in-network

Modio’s OneView® helps practices stay on task by sending reminders for license and DEA renewals and tracking recredentialing dates. Without a dedicated credentialing team, small practices end up relying on calendar reminders and Google spreadsheets. That works until it doesn’t. “If you have one person that’s trying to manage a practice, manage patient care, manage billing, manage credentialing, sometimes you run the risk of having something fall through the cracks,” said Amy Mooney, delegated credentialing specialist at Modio Health.

Communication matters too. When several people touch the process, everyone needs to know who contacted which payer and what’s been approved. Credentialing software with notes and tracking capabilities, like Modio’s, gives the team a shared record instead of scattered emails and memory.

Education and experience are key to credentialing success

One of the biggest issues for small practices that credential providers in-house is a lack of understanding of how the process works. “Provider credentialing requires a certain amount of education, and there is a lot of attention to detail needed,” Amy said. “Every payer has its own set of guidelines and requirements. If you go into it not fully understanding the process or the turnaround time with some of these payers, that’s a challenge.” And practices can suffer.

A dedicated credentialing partner can walk you through the process from start to finish, taking the burden off staff and keeping small practices on track. Turnaround time is one place a partner shows up in the numbers. Modio’s average enrollment turnaround is 60 days, compared with an industry range of 90 to 120 days. That is 30 to 60 days sooner, or 33% to 50% faster. For a small practice, those weeks are the difference between a provider seeing patients and waiting on a payer.

Key elements to look for when choosing a credentialing partner include:

• Visibility: Can you track your provider applications as they move through the process?
• Communication: Will someone answer your questions promptly?
• Education: Will they explain how things work, not just do the work?
• Accountability and experience: Do they know the payers? 

Larger organizations can also benefit. Even health systems with credentialing departments sometimes get overloaded and need support.

Let providers focus on patients

At the end of the day, the goal of partnering with a credentialing team is to take the stress off providers and support the practice overall with this complex but important process.

“Working with payers can be challenging, but as I remind myself, we’re doing our piece in order to make sure that provider can focus on patient care,” Amy said.

For small practices, getting ahead of credentialing means starting early, staying organized, and getting the right help, so providers can spend their time with patients and practices thrive.

See how Modio’s OneView can help streamline your small practice’s credentialing today.