I'm going to say something you probably don't expect from a credentialing company: not every practice should outsource credentialing.
I mean that. If you have a dedicated, experienced credentialing coordinator, a small provider roster, a stable payer mix, and the internal bandwidth to do this right — you may not need us. I'd rather tell you that upfront than sell you a service you don't need.
What I can tell you, from years of doing this and talking to hundreds of practices, is exactly what the conditions look like when in-house stops working and outsourcing starts paying for itself. Let me lay it out clearly so you can make a genuinely informed decision.
When In-House Credentialing Actually Works
✅ In-House Works Well When...
- You have 1–3 providers with a stable payer mix
- You have a dedicated, trained credentialing coordinator (not a billing person handling it part-time)
- Your CAQH profiles are current and re-attested regularly
- You have a written re-credentialing calendar and follow it
- You haven't had a credentialing lapse in the past 2 years
- Your denial rate attributable to credentialing issues is below 2%
✅ Outsourcing Wins When...
- You're adding 2+ providers per year
- Credentialing is handled by someone with 5+ other responsibilities
- You've had even one credentialing lapse in recent years
- You're entering new states, payers, or telehealth markets
- Your team doesn't track re-credentialing dates until payers notify you
- Your denial rate has unexplained spikes you can't diagnose
The 7 Signals We Hear From Practices That Come to Us
Credentialing takes up 10+ hours per week of staff time
At a fully-loaded cost of $25–40/hour for an admin person, that's $1,000–$1,600/month in internal cost alone. Most outsourced credentialing services cost less and produce better outcomes. Run the real math before assuming in-house is cheaper.
You've had at least one credentialing lapse in the past 24 months
One lapse usually means the system has a structural problem — not a one-time mistake. It will happen again without a process change. A managed credentialing service removes the dependency on any single person's calendar or attention.
You're hiring providers faster than your team can process them
Each new provider needs a full credential cycle with every payer. At 90–120 days per payer and potentially 10+ payers per provider, this scales rapidly. A 10-provider group adding 3 new providers per year has 30+ parallel credentialing tracks to manage.
You're expanding into new states or payer markets
Every new state has different Medicaid requirements, different major payers, different timelines, and different re-credentialing cycles. If you don't have experience with those specific markets, you're going to make expensive mistakes. We make them once and build a system. You're making them for the first time.
Your denial rate is above 5% and you can't identify the credentialing contribution
If you can't separately track which denials are credentialing-related, you almost certainly have credentialing-related denials you don't know about. The visibility problem is as serious as the denial problem itself.
Your credentialing person is about to leave (or just did)
This is the single highest-risk moment for any practice that manages credentialing in-house. If the person who held all the institutional knowledge just resigned, you're potentially weeks away from missing critical deadlines you don't even know exist.
You learn about re-credentialing deadlines from the payer, not your own system
If the payer is the one notifying you that re-credentialing is due, you're already 30–60 days behind where you should be in the process. A proactive managed service should be alerting you and beginning the process before the payer ever says a word.
Not Sure Where You Fall? Let's Look Together.
We offer a free credentialing health assessment — we'll look at your current status, identify your risk exposure, and tell you honestly whether you need help or whether your current system looks solid. No sales pitch, just the real picture.
Schedule Your Free Assessment