{"id":6073,"date":"2026-11-06T09:30:00","date_gmt":"2026-11-06T09:30:00","guid":{"rendered":"https:\/\/www.modiohealth.com\/life\/?p=6073"},"modified":"2026-11-04T19:27:47","modified_gmt":"2026-11-04T19:27:47","slug":"how-small-provider-practices-can-get-ahead-of-credentialing-challenges","status":"publish","type":"post","link":"https:\/\/www.modiohealth.com\/life\/credentialing\/how-small-provider-practices-can-get-ahead-of-credentialing-challenges","title":{"rendered":"How Small Provider Practices Can Get Ahead of Credentialing Challenges"},"content":{"rendered":"\n

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<\/a> 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 \u2014 smaller practices usually don\u2019t. That means the work falls to whoever has time, and more often than not that\u2019s an office or billing manager, a practice administrator, or even the provider.<\/p>\n\n\n\n

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\u2019t 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.<\/p>\n\n\n\n

Why credentialing gets complicated fast<\/strong><\/h2>\n\n\n\n

It\u2019s 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\u2019s 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\u2019s office doesn\u2019t require.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

The time adds up. In a CAQH survey<\/a> 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.<\/p>\n\n\n\n

Credentialing is never a one-time task<\/strong><\/h2>\n\n\n\n

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.<\/p>\n\n\n\n

The clock never stops. CAQH requires providers<\/a> 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.<\/p>\n\n\n\n

Credentialing requires ongoing maintenance and follow-up to keep providers compliant and in network with payers, including:<\/p>\n\n\n\n