• May 13, 2025
• | Credentialing

When we think about what keeps a healthcare system running, it’s often the clinical that jumps to the forefront — cutting-edge treatments, skilled physicians and nurses, new innovations in AI, and so forth. However, behind every provider seeing patients is a critical but often overlooked process: provider credentialing. 

Provider credentialing, the process of verifying a healthcare provider’s qualifications to ensure they’re fit to deliver care, is the gateway that allows clinicians to practice medicine, see patients, and get reimbursed by payers. And in today’s healthcare environment, where staffing shortages are common, regulations are tightening, and telehealth is expanding rapidly, an inefficient credentialing process is no longer just a headache — it’s a significant and costly problem that can cause issues for your organization. 

So let’s get back to the basics of provider credentialing and take a deeper look at the hidden challenges to be aware of, why updating your process matters, and where to even begin.

The hidden challenges of credentialing

Provider credentialing sounds straightforward on paper, but in practice, it’s anything but. Many organizations still rely on manual processes (think Excel spreadsheets and Post-it Notes), which can result in errors, long wait times to onboard providers, loss of revenue, and, ultimately, delays in patient care. 

Delays in credentialing can keep qualified providers from seeing patients for weeks or even months, putting strain on overworked teams. Red tape — from chasing down missing documents to navigating payer requirements — adds layers of complexity. And let’s not forget the administrative waste: repetitive data entry, disjointed systems, and endless back-and-forth with insurers.

The ripple effects are substantial. Providers can’t bill for services they’re not authorized to deliver. It also fuels provider burnout, as clinicians and staff wrestle with avoidable administrative hassles.

Modernizing credentialing matters

The good news is that organizations that prioritize modernizing their credentialing processes are seeing big payoffs. By streamlining credentialing, hospitals and medical practices can reduce lost revenue by getting providers onboarded and billing faster. They can also improve patient access and care by filling scheduling gaps sooner. Teams are also freed up to focus more on patient care instead of paperwork.

The first mindset shift is realizing that credentialing isn’t a one-and-done event — it’s a life cycle. Licenses expire. Certifications need to be renewed. Payer requirements change. An organization’s credentialing process needs to be equipped to handle all of it, not just initial verification.

To stay ahead, credentialing teams need a centralized platform, like Modio’s OneView that tracks everything from expirations to renewals to payer contracts. Spreadsheets may work for practices managing a handful of providers, but they don’t scale. A credentialing platform like OneView automates repetitive tasks, streamlines workflows, issues real‐time alerts, and generates actionable reports so your team can stay proactive and organized.

It’s also critical to define ownership: Who is responsible for credentialing internally? What will be outsourced to a third party? Clarity around roles ensures accountability and avoids important steps falling through the cracks.

Why Now Is the Time To Act

The urgency to get organized has never been greater. Regulators are paying closer attention to provider data accuracy. Workforce models are evolving fast — from telehealth to traveling nurses to locum tenens providers — and they demand speed and flexibility in credentialing. 

Meanwhile, patient expectations are shifting toward a more seamless, retail-like healthcare experience.

The human cost is also a big factor. Provider burnout continues to be an issue across healthcare, and endless, complicated administrative tasks only make it worse. Organized credentialing reduces friction for both providers and staff, supporting faster onboarding, smoother audits, and ultimately better care.

So where should you start? Here are a few recommendations: 

• Conduct a credentialing process audit. Map out current workflows, identify bottlenecks, and look for opportunities to improve.
• Organize data. Centralize provider files and ensure data is complete and up to date.
• Review your technology. Whether it’s upgrading your credentialing platform or adding automation, make sure your tools are up to the job.
• Track key metrics. Keep an eye on turnaround times, error rates, and days to revenue — they’ll show you where progress is happening (and where it’s not).
• Keep an open mind to innovation. Credentialing, like the rest of healthcare, is evolving — build flexibility into your processes to keep up.
  
  

If 2025 has shown us anything, it’s that change is happening quickly in the healthcare sector, and modernizing your credentialing process isn’t just a nice-to-have — it’s a strategic advantage.

It saves time, protects revenue, and helps teams stay focused on what matters most: delivering great care to the patients who need it. By investing in better credentialing now, you’re setting your organization up for stronger performance and a healthier future.

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