Why is Our New Provider Not Yet Enrolled? A Guide to Speeding Up Payor Credentialing

One of the most frustrating questions rural hospital executives face is a direct challenge to the revenue cycle: “Why isn’t our new provider enrolled yet? They started 30 days ago.”

The pressure to generate revenue immediately upon a provider’s start date is immense. However, believing enrollment takes just 30 days is a dangerous myth that sets your hospital up for financial disappointment and administrative chaos.

Setting Realistic Expectations: The 90–180 Day Reality

Regardless of how dedicated or organized your credentialing team is, the average payor enrollment turnaround time is 90–180 days. This extended timeline is largely governed by external processes – the internal processing queues of Medicare, Medicaid, and various commercial insurance networks. While you cannot force a payor to skip their queue, you can control the internal bottlenecks that often add weeks or even months to the official timeline.

The difference between a 90-day enrollment and a 180-day enrollment is almost always within your hospital’s control.

5 Internal Bottlenecks Your Leadership Must Eliminate

To accelerate enrollments and capture revenue faster, executives must establish policies that treat enrollment as a strategic, year-round operational priority, not a clerical task.

1. Shift Document Collection to Pre-Hire

The first delay often happens before the application is even submitted. Stop waiting for the provider’s start date or even the signed contract. Implement a policy to gather all payor-required documentation—such as DEA certificates, educational transcripts, and full work history – during the interview and initial medical staff credentialing phase. If the candidate makes the shortlist, the document clock starts immediately.

Executive Action: Integrate required payor enrollment documents (DEA, NPI, transcripts) into the final phases of your recruitment and initial credentialing applications to ensure full documentation is ready the day the offer is signed.

2. Educate Your New Hires (Especially Graduates)

New physicians and advanced practice providers (APPs) often lack experience with the lengthy enrollment process. They may not understand that a two-week delay in submitting one required document can translate into a two-month delay in claims payment.

Executive Action: Ensure your onboarding includes a mandatory 15-minute briefing that explains the direct link between prompt documentation submission and the provider’s ability to see and bill for patients. This is critical for recruiting new graduates who are eager to start practicing.

3. Transition from “One-and-Done” to Continuous Maintenance

Viewing payor enrollment as a task you only tackle right before a revalidation date is a recipe for disaster. This leads to a mad scramble to update expired documents, often after the payor has already removed the provider from active enrollment status.

Executive Action: Mandate that credentialing teams transition to a continuous maintenance model. Dedicating a few minutes each month to proactively update a few expiring documents is far more efficient than blocking out two hours of administrative time right before a deadline.

4. Monitor Proactively, Don’t Wait for Payor Notices

Payors often wait until the last minute – sometimes even after the effective date has lapsed – to send renewal or revalidation notices. The burden of compliance and continuity falls squarely on the hospital.

Executive Action: Do not rely on external notices. Your credentialing software or system must be the single source of truth for tracking every provider’s expiration date. Ensure renewal applications are submitted 90–120 days before the actual expiration date, regardless of whether a notice has been received.

5. Prioritize Contract Review and Negotiation

Once the credentialing specialist successfully secures payor approval, the final step is contract review and signature. This is where applications often stall, sometimes sitting on an executive’s desk for weeks. Every day a contract remains unsigned is a day of lost revenue opportunity, as the effective date often cannot be activated until the contract is finalized.

Executive Action: Treat approved payor contracts as a top-tier priority. Create a fast-track process for executive review and signature to ensure the enrollment’s effective date is activated immediately upon approval.

The Waiting Game: How to Manage the External Delay

Once a clean application is submitted, the process is largely out of your hands. The only effective strategy here is aggressive, persistent follow-up. Ensure your credentialing team has a system to check the status of all pending applications every 1–2 weeks. This persistent “prodding” prevents applications from falling into a payor’s processing black hole and is the only way to gently accelerate external timelines.

Ready to accelerate your provider enrollments and revenue cycle? Schedule a brief, direct call with our team to discuss your current bottlenecks: https://doorspaceinc.com/schedule-call/