The revenue is leaving. The payer is holding it. And the organization is calling it a paperwork problem.
Years ago, I watched a newly hired physician sit in clinical limbo for nearly six months while a payer worked through her credentialing application. She was seeing patients. She was generating claims. And because her credentialing was not complete, not a single one of those claims was being paid.
The practice was absorbing her salary, her overhead, and her productivity. The payer was holding the revenue. I called it administrative inefficiency at the time.
I have since reconsidered that label.
What Drew's Day Actually Looks Like
Drew manages provider enrollment for a health system that is growing. New physician hires. Expanding specialties. New market footprints that need in-network coverage activated before the first patient walks in the door.
His team tracks applications, chases documentation, follows up with payer credentialing departments, and moves files through a process that feels, most days, like pushing water uphill. When something is delayed, the answer he gets is some version of: it is in process, these things take time, we are working through a high volume of applications right now.
Drew accepts that answer because the system has trained him to. Because credentialing has always been framed as an administrative function with administrative timelines and administrative solutions.
What nobody has told Drew is that his credentialing queue is a financial instrument. And the payer on the other end of it understands that better than he does.
Follow the Money
A provider who cannot bill for services rendered is generating claims that sit unpaid. The payer is collecting premiums from members who are receiving care. The revenue from that care is not flowing to the provider. It is staying with the payer, interest-free, for the duration of the delay.
That dynamic has a financial beneficiary. It is not Drew's organization. It is not the patient. It is the payer.
Every week a credentialing application sits in a queue is a week the payer retains revenue it is contractually obligated to release. Whether that outcome is intentional or incidental, the incentive structure rewards delay. And most organizations respond to incentive structures exactly as you would expect.
Yes, credentialing delays have legitimate explanations. System backlogs, staffing gaps, documentation gaps, human error. None of that is fabricated. But an explanation is not the same as a justification, and a delay that is nobody's fault is still costing Drew's organization money while the payer holds the revenue. Unintentional is not the same as neutral.
What the Pattern Looks Like When You Know What to Look For
Credentialing delays cluster in predictable ways. New physician hires at the start of a fiscal year, when payer credentialing departments are managing high application volumes. Specialist categories where payer panels are allegedly full. Markets where a health system has recently expanded and the payer has motivation to slow the onboarding of new in-network capacity.
Each delay is individually explainable. There are legitimate administrative reasons for every one of them. But a pattern across multiple providers, multiple specialties, and multiple contract cycles tells a different story than any single application delay would suggest on its own.
The question worth asking is why this payer's credentialing timeline consistently runs longer than others, in specific provider categories, in specific markets, at specific times of year. When the answer to that question correlates with periods of financial pressure on the payer's side, the administrative inefficiency explanation becomes very difficult to sustain.
Drew has the data to see that pattern. He has just never looked at it that way.
Four Things that Drew Can do to Changes the Conversation
Measure credentialing delays in dollars, not days. Every day a provider is seeing patients without active credentialing is a day of unbilled or uncollectable revenue. Drew should be quantifying that figure by provider, by specialty, and by payer on a rolling basis. When leadership sees credentialing delays expressed in dollars rather than days, the urgency of the issue changes immediately. And Drew's seat at the table changes with it.
Get contractual language that makes timelines an obligation, not a courtesy. Most managed care agreements are silent on credentialing turnaround times. They should not be. Specific turnaround commitments, with defined escalation rights and retroactive payment provisions when timelines are missed, convert a payer courtesy into a contractual obligation. That language exists and can be negotiated. Most health systems are not asking for it. Drew should be the reason his organization starts.
Escalate pattern delays through payer relations, not just enrollment. A single delayed application is an enrollment problem. A pattern of delayed applications with a specific payer is a contract performance problem. It belongs in the joint operating committee agenda, in VP-level payer conversations, and in the pre-negotiation brief as documented evidence of payer behavior. Drew moving a pattern delay up through the payer relations channel rather than absorbing it inside enrollment is one of the highest-value escalations his organization is currently not making.
Build the delay history into the next negotiation. Credentialing delay patterns, quantified by provider, specialty, days delayed, and estimated revenue impact, are legitimate negotiating data. A payer that has cost an organization two million dollars in delayed revenue over a contract term through credentialing patterns has handed that organization a fact-based argument for rate, for terms, or for both. Drew is sitting on that argument. It belongs across the table at the next renewal.
The Bottom Line
Drew did not design the issue he inherited. Credentialing has always been processed as an administrative function, and so that is what it became: a workflow to manage rather than a financial position to protect.
The financial consequences of credentialing delays fall entirely on providers and patients while the payer holds the revenue and faces no contractual accountability for the timeline. That is not a bureaucratic inconvenience. It is a structural imbalance with a measurable dollar figure.
Drew has the data to name it, quantify it, and bring it into the conversations where it belongs. The question is whether his organization is ready to stop calling it a paperwork problem.
About the Author
Kevin W. Barron, MBA, FHFMA, FACHE is a nationally recognized healthcare contracting and payer relations executive with over 30 years of experience in healthcare finance. He is an author, speaker, and mentor to emerging leaders in healthcare finance. Follow Kevin on LinkedIn or subscribe to his weekly newsletter at https://www.KevinWatsonBarron.com
Disclaimer: This article is provided for general informational and educational purposes only. It reflects my personal views and observations based on professional experience in healthcare finance, managed care, payer relations, and revenue cycle operations. It should not be interpreted as legal, financial, regulatory, actuarial, or reimbursement advice. The content is not intended to represent the official position of my employer, any payer, provider, professional association, or other organization with which I may be affiliated. Readers should consult their own legal, financial, compliance, actuarial, or operational advisors before making decisions based on the issues discussed. Any references to payers, providers, regulations, market trends, or reimbursement practices are intended for discussion and education only and should not be construed as a statement about any specific contract, negotiation, patient matter, or confidential business arrangement.