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Credentialing: hire a specialist, pay a company, or bundle it with billing?
A new provider signs with your practice. They’re licensed, ready and keen to start. Then someone asks which insurers they can see patients for, and the answer is none yet.
Until each insurer approves them, their visits can’t be billed in network. So the practice either holds back their schedule or sees patients and hopes the approvals land in time.
Credentialing is slow, dull work with long waits in between. That’s why it slips. This article covers what it involves, what it costs, and the cheapest way for a small practice to get it done.
The numbers
How long it takes. Medicare’s own processing target is about 45 days for an online application through PECOS and about 60 days on paper, according to CGS, one of Medicare’s regional contractors. That clock only counts from a complete application, and missing signatures or documents stop it.
Commercial insurers are slower and less predictable. The figure most often quoted is 90 to 120 days, with 45 to 180 days not unusual. Treat that as an industry estimate. It varies by insurer and by state.
What credentialing companies charge. Vendor pricing pages put it at about $100 to $500 per insurer application, per provider. Many also charge a monthly fee to keep each provider’s profiles current, commonly $100 to $500 per provider.
What a full-time specialist costs. A local US medical records specialist averages $56,790 a year, about $81,129 with benefits and payroll taxes (BLS, May 2025). Even a remote specialist is a full salary: $2,800 a month through Benchwell.
How it works
Credentialing is really 3 jobs that people tend to lump together:
- Credentialing. The insurer checks the provider: licence, training, board status, malpractice history, work history.
- Enrolment. The insurer adds the provider to its network and sets them up so claims can be paid.
- Upkeep. Most commercial insurers pull provider data from a CAQH profile, which has to be re-attested at least every 120 days, even when nothing has changed. And under NCQA standards, which most health plans follow, each insurer re-checks every provider at least every 36 months.
The work comes in bursts. There’s a lot of it when you open, add a provider or move into a new state. In between, there’s very little.
Your 3 options
1. A credentialing company. You pay per insurer application. It’s a sensible choice if your billing is already sorted and you only need a few applications done.
2. A full-time credentialing specialist. Only worth it for large practices or groups that add providers all the time, or open new locations every year. For most small practices there isn’t a full-time job’s worth of credentialing, so you’d be paying a salary for a lot of waiting.
3. Bundle it with your billing. Credentialing and billing are 2 ends of the same chain. If the provider isn’t in network, there’s nothing to bill. A billing team already talks to your insurers every day, so it can handle the applications for much less.
Here’s what that looks like for a practice with 2 providers and 8 insurers each, so 16 applications:
| Option | Cost of the 16 applications |
|---|---|
| Credentialing company, at $300 an application (middle of the vendor range) | $4,800 |
| Credentialing company, anywhere in the $100 to $500 range | $1,600 to $8,000 |
| Benchwell, with managed billing, at $100 per insurer, per provider | $1,600 |
| A full-time specialist | $2,800 every month, whether there are applications or not |
Our honest view: if you’re a small practice, don’t hire a full-time credentialing specialist. Either pay per application, or get it done alongside your billing.
Where the money leaks
Credentialing is the first link in the chain. A provider who isn’t in network can’t bill, so nothing after it matters until it’s done.
The leaks we see most often:
- Late starts. Applications go out after the provider’s first day instead of the day they sign. That can cost months.
- Applications that sit. Insurers rarely chase you. If nobody follows up, a missing document can hold an application for weeks without anyone noticing.
- Lapsed CAQH profiles. Insurers can drop the provider from their directories, and new patients can’t find them.
- Missed re-credentialing. An insurer can stop paying until it’s sorted, and claims pile up in the meantime.
- Credentialing and billing that don’t talk. The biller sends claims for a provider whose approval hasn’t come through, and they come back denied.
Medicare does allow some back-billing. In some cases a provider can bill for services up to 30 days before their enrolment’s effective date. That’s a safety net, not a plan, and most commercial insurers are stricter.
Where Benchwell fits
With managed billing. We run your billing from claim to payment, and we do your credentialing for $100 per insurer, per provider. Your applications are prepared, submitted and chased by the same team that will bill those insurers, so claims start going out as soon as approvals land.
Credentialing only. If your billing is already in good hands, we can still do your credentialing, priced per insurer application. Ask us for a quote.
A full-time specialist. For large groups that keep adding providers, we can find and test a dedicated remote credentialing specialist for $2,800 a month. You interview the strongest few and pick.
Before anyone handles your providers’ details or patient data, we sign a BAA, and everyone on your account completes HIPAA training and works on a company-managed laptop.
What we don’t do: we don’t negotiate your contract rates with insurers. That’s a different job, and it’s worth paying a specialist firm or a healthcare lawyer for it.
Want to see what it would cost you? Start with a free billing review. Send us a recent claims and denials report and the insurers you want to join, and we’ll quote billing and credentialing together.
Sources: Medicare processing targets from CGS Medicare. Commercial timelines and company fees are industry estimates from vendor guides, including Carepatron, so treat them as a guide and get written quotes. CAQH 120-day re-attestation as described by Priority Health and Blue Cross Blue Shield of Michigan. 36-month re-credentialing: NCQA credentialing standards. Medicare back-billing: 42 CFR 424.521. US salary: BLS Occupational Employment and Wage Statistics, May 2025, national mean. Benefits and payroll taxes: salary divided by 0.7, from BLS Employer Costs for Employee Compensation.