Healthcare technology conversations often focus on improving efficiency at the point of care — reducing the note-taking burden, streamlining workflows, adding telehealth capabilities and giving clinicians more time with patients. These investments are necessary, particularly as provider burnout remains a persistent challenge.
But for many clinicians, administrative burden begins long before they see their first patient. One of the most overlooked contributors is provider credentialing, a process essential to patient safety, compliance and reimbursement, yet often treated as a back-office formality.
In reality, credentialing is a critical gatekeeper for workforce capacity and revenue. Manual, fragmented processes can delay provider onboarding by months, preventing clinicians from delivering care or generating revenue while compounding administrative strain.
Modernizing credentialing with technology represents one of the fastest, most tangible opportunities to reduce clinician burden, accelerate time to practice and unlock capacity that has long been hiding in plain sight.
The costs of credentialing: out of sight, out of mind
Medical education programs rarely cover the necessity of credentialing for clinicians, including physicians, nurse practitioners, physician assistants and respiratory therapists.
John Bou, president and co-founder of Modio Health, underscored the risks of overlooking credentialing: “You only hear about credentialing when something goes wrong. Yet it’s critically important for healthcare — without it, providers can’t see patients or get paid.”
“No one discusses how providers will be allowed to practice in the hospital,” Kirk Heath, MD, co founder of Modio Health, said. “When clinicians get out of medical school or residency programs, they’re hit with the administrative burden of the credentialing process.”
At the same time, many healthcare organizations have historically treated credentialing as a behind-the-scenes function. Decentralized, manual processes are often managed by back-office teams with limited visibility across the broader enterprise.
Given this context, it’s not surprising that healthcare technology initiatives have largely overlooked credentialing, focusing instead on higher-profile investments, such as making visits more efficient, expanding patient access or streamlining surgery and clinical decision-making.
This trend is problematic, however. When credentialing processes fail or lag behind, everything downstream suffers — from revenue to staffing and compliance.
The financial consequences of outdated credentialing systems are often underestimated. Delays in onboarding providers translate into lost billable time, administrative rework, duplicative verifications, staff burnout and limited access to care for patients.
As a workaround, organizations may turn to emergency or temporary provider privileges. While this may enable clinicians to deliver care, they can’t get paid for services until they are fully credentialed. Retroactive billing for services is possible, but it’s costly and labor-intensive, John explained.
Investing in the right technology can address these challenges. Advanced credentialing platforms centralize data, automate primary source verification and minimize errors. This reduces onboarding time, which enables clinicians to get to work faster and generates more revenue for hospitals and health systems.
Dr. Heath noted that after organizations adopt Modio OneView©, credentialing processes that previously took 80 to 120 days now take less than 30 days.
“If you think about what an average physician or surgeon bills, it’s probably thousands if not tens of thousands of dollars per day,” he said. “Reducing the time to bill to 30 days means that hospitals can begin generating significant revenue much sooner.”
Streamlined credentialing: an antidote for provider retention + patient access challenges
Burnout is still a top-of-mind issue for providers and healthcare leaders alike. While many factors contribute, administrative friction continues to play a major role. Streamlining the credentialing experience is one way organizations can reduce unnecessary burden, ease frustration and support provider retention. Efficient, transparent processes not only accelerate onboarding but also signal operational competence from day one.
For many clinicians, administrative tasks accumulate over time, eroding morale and engagement. Credentialing is a part of that burden — and often a provider’s first interaction with a new organization. When the experience is slow, opaque or duplicative, it sets the wrong tone. “Over 90% of the time when a doctor starts a job at a new organization, the credentialing process is not pleasant, no matter how nice the people are,” Dr. Heath said.
To illustrate the daunting nature of credentialing, Dr. Heath explained how he recently had to complete a credentialing application as part of getting a license in another state. This required proof of employment at the first surgery practice he ever worked at — decades ago. “This is almost making me not want to get the license,” he said. “And past employment history is just one element of around 80 in the credentialing application.”
The fragmented, decentralized nature of credentialing further compounds the burden on clinicians. Providers must complete separate credentialing processes for every healthcare organization with which they are affiliated. For some physicians, this can mean submitting the same information dozens of times across multiple entities.
When Dr. Heath practiced medicine in Virginia, for example, he worked in four hospitals across three health systems, two ambulatory surgery centers and interacted with approximately 25 payers. “Every one of those entities had to credential me,” he said. “So I had to supply 100 data points to over 30 different organizations. It was a tremendous burden.”
Leveraging technology to streamline credentialing not only enhances the provider experience, it also increases patient access to care. Getting clinicians on the job faster is essential for serving patients, especially in rural communities and other “care deserts” where provider shortages are most acute.
Risk reduction: credentialing technology protects people + organizations
Legacy credentialing processes carry real compliance risks, such as patient safety concerns, privileging gaps, audit findings and lapsed licenses.
Outdated data also introduces material risk. Many healthcare organizations still rely on spreadsheets and paper-based files, limiting their ability to maintain accurate, current provider information. Without real-time updates, organizations face gaps in background checks and increased exposure to compliance risk, allowing providers with unresolved issues or prior sanctions to go undetected. “A provider may have red flags in other states, for example, but hospitals have no visibility into that. A system with data that’s updated in real time is critical for compliance,” John said.
Manual credentialing is also error prone and labor intensive. As part of the process, it’s common for backoffice staff to visit various websites, enter data and then re-enter that information into other systems. Dr. Heath described these manual workflows as fraught with errors.
Software-based solutions that support computer-to-computer connections remove the human element, which reduces errors. This is essential, Dr. Heath said, since clean data is the foundation of sound credentialing. Technology-based credentialing platforms allow healthcare organizations to reduce the labor required to manage credentialing at scale.
“Through automation, it’s possible for hospitals to reduce the number of individuals involved in the credentialing process from seven to one or two,” Dr. Heath added.
When it comes to compliance, another benefit of technology-enabled credentialing systems is license renewal reminders. Dr. Heath recalled a recent high profile case, in which a doctor’s state license lapsed because the office manager missed the state board of medicine’s renewal reminder. The provider inadvertently ended up practicing without a license for a period of time. “This doctor was fined $10,000, but it had nothing to do with her clinical capabilities. In addition, the infraction will sit on her record forever,” Dr. Heath said.
Modern credentialing technology protects patients, providers and organizations from these types of risks by maintaining a single source of truth, automating alerts and ensuring compliance across state lines and care settings.
The future of credentialing: strategies + tactics
Verifying provider identities and qualifications continues to be a challenge for hospitals and health systems. Some healthcare leaders believe the ideal solution would be a nationally standardized approach to provider licensing and a centralized source of truth for provider credentialing information.
With the Interstate Medical Licensure Compact, some progress has been made on standardizing provider licenses across states. However, achieving a national system for credentialing information is unlikely without establishing governing bodies. In the interim, the best path forward for healthcare organizations is applying credentialing technology solutions.
John explained that although credentialing is complicated, it’s not complex. As a result, technology is well-suited for automating workflows and retrieving provider licenses more rapidly.
To ensure that credentialing technology investments deliver measurable value, John and Dr. Heath recommend that organizations first articulate their goals and desired outcomes. Key focus areas may include cost cutting, error reduction or risk minimization when bringing new providers into a hospital or health system.
“Credentialing outcomes can be defined and measured quite easily,” Dr. Heath said. “The goal is for the process to be as fast and accurate as possible. I would focus on how long it takes to credential a file from start to finish and the time required for each step.”
Next, it’s important to identify current metrics related to credentialing and the desired targets. Metrics can help show whether credentialing solutions are increasing revenue, decreasing costs or lowering system risk.
“Many times, when we engage with healthcare organizations, they aren’t sure where there are inefficiencies in their credentialing because they don’t have a baseline to understand the issues and what improvement looks like,” John said.
More healthcare organizations are recognizing the value of standardizing and modernizing their credentialing processes. By using technology-based solutions like Modio, hospitals and health systems are reducing the provider burden associated with credentialing, while ensuring newly hired clinicians can deliver care sooner. The results are increased revenue, higher levels of staffing capacity and expanded patient access.
“Credentials are critical for patient safety and risk mitigation in healthcare organizations,” John said. “With the right focus and investment, we may eventually get to a seamless, national process — until then, we can improve the process by leaps and bounds with technology. There’s lots of room for improvement, and we’re getting there a step at a time.”
The post The hidden costs of outdated credentialing — and the case for modernization appeared first on Becker's Hospital Review | Healthcare News & Analysis.
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