Provider credentialing has become increasingly complex. With requirements such as payer re-verifications, director accuracy requirements, and evolving federal regulations, even small missteps can result in delayed reimbursement or network removal. Principal and Healthcare Advisor Stewart Garner, MSHA, CMPE recently shared insight on provider enrollment and credentialing with the Birmingham Medical News in their March issue.
Common Credentialing Challenges Facing Medical Practices Today Include:
- Increased administrative burden tied to payer and regulatory changes, especially for medical practices without dedicated credentialing teams
- Ongoing directory maintenance requirements that must be completed on tight timelines
- Greater reliance on centralized data platforms, such as the Council for Affordable Quality Healthcare (CAQH), requiring constant updates
- Patient access disruptions when providers are dropped from networks or temporarily placed out of network due to credentialing lapses
- Financial risk when credentialing lapses lead to out‑of‑network status
Garner discussed how credentialing requirements, particularly requirements around provider directory accuracy and payer enrollment, have added new layers of complexity for medical practices. His perspective underscores what many providers are experiencing firsthand: credentialing is no longer a “set it and forget it” function.
For many medical practices, managing credentialing demands internally is overwhelming and time consuming. That’s why many organizations are rethinking how credentialing fits into their overall operations strategy.
Kassouf’s Credentialing Services Team helps practices stay compliant, avoid costly delays, and keep providers in-network. Explore our credentialing services and how we can support your practice.
Read Garner’s full perspective via the Birmingham Medical News.