In the healthcare ecosystem, provider credentialing is essential to maintain high standards of care quality and compliance. Despite its critical role in safeguarding care quality and regulatory adherence, credentialing is often seen as an administrative burden rather than a strategic lever for performance.
The cost of this perception is high. Credentialing delays go beyond operational inefficiencies and lead to revenue leaks and access barriers. Industry reports estimate that delays can cost a medical group over $1.8 million in lost revenue per provider. Recognizing these risks, the National Committee for Quality Assurance (NCQA) further raised the urgency by shortening credentialing timelines, reducing the verification window from 180 days to 120 days for health plan accreditation, and to 90 days for credentialing certification. While these changes are designed to accelerate provider onboarding and improve access to care in a timely manner, they also emphasize the need to modernize provider credentialing with AI-led digital solutions to reduce turnaround time, minimize errors, and ensure compliance.
These shifts demand a step-change in how healthcare organizations manage provider onboarding. As healthcare systems grow more complex, modernizing credentialing with AI-led digital solutions has now become a strategic lever for healthcare providers. Intelligent automation can accelerate verification, minimize human error, ensure compliance, and ultimately transform credentialing from a bottleneck into a competitive advantage.
This blog highlights the challenges inherent in traditional methods and how AI-driven credentialing can enable organizations to meet evolving demands with speed, accuracy, and confidence.
what is provider credentialing?
Provider credentialing and recredentialing is the process of gathering, verifying, and validating a provider’s information to ensure they meet the high standards required to deliver patient care. This includes confirming identifiers, such as NPI numbers, education and work history, licenses, addresses, affiliations and associations, etc. Various data sources are leveraged to gather this information along with primary source verification.
While essential, credentialing is also high-cost, time-intensive, and fragmented. Document verification across disparate systems also increases administrative overhead and introduces data entry risks, delays, and non-compliance with regulatory standards. Such challenges lead to significant operational costs and loss of revenue, while also delaying provider onboarding and their ability to deliver patient care.
challenges with traditional credentialing methods
Traditional credentialing methods tend to be inefficient, cause delays, and impact revenues. Some of the key challenges and risks of traditional credentialing methods include:
- time-consuming and error-prone process: credentialing can take up to 180 days to complete, causing onboarding delays and reducing billable hours. According to a Medallion survey, 60% of healthcare administrators spend more than half a business day on primary source verifications, a task that is often riddled with errors and data inconsistencies.
- complex document requirements: credentialing involves the collection and verification of a variety of documents, including academic transcripts, residency/fellowship certificates, licenses, DEA registration, etc. Faced with manual verification of multiple documents, healthcare organizations often have to contend with errors and credentialing delays that impact revenue. As per the Medallion survey, 46% respondents reported that unoptimized enrolment workflows have impacted their healthcare organization’s revenue.
- compliance and audit risks: credentialing requires adherence to standards and compliance with state and federal regulations. However, long administrative hours due to manual workflows can result in compliance issues, increasing the risks associated with outdated or inaccurate information and impacting the quality of care.
- lack of ongoing monitoring and recredentialing: credentialing isn’t a one-time process. Providers must be monitored and recredentialed periodically to ensure their credentials remain valid and their in-network (INN) status is up to date. Without continuous oversight, organizations risk network inaccuracies and regulatory penalties.
faster, smarter credentialing with transformation and analytics
To address the challenges of traditional credentialing methods, businesses must leverage Agentic AI-driven automation solutions that streamline the entire process, from initial application submission to final approval. Key capabilities - autonomous capabilities to execute each task of the credentialing workflow with domain specific agents with human validation
- AI-powered data classification: advanced generative AI model which extracts data from transcripts, licenses, and certificates with high accuracy. This minimizes the need for manual data entry, reducing errors and enabling faster application processing.
- real-time verification and data integration: AI-enabled systems can access data in real time from trusted primary sources, such as NPDB, LEIE, SAM, CMS, CAQH, etc. to integrate provider data and verify provider credentials. These integrations allow access to up-to-date information on millions of healthcare professionals, thereby informing and facilitating credential decisions and providing an interactive user interface to showcase the validation sources for easier reference.
- optimized workflows with automated solutions: automated credentialing solutions can be configured to manage complex workflows, including initial credentialing, recredentialing, digital attestations, reviews, and approvals. Agentic AI ensures these steps are completed on time and their status is tracked with built-in notifications to prevent delays and bottlenecks.
- data reconciliation: AI systems can detect anomalies, identify missing information, and flag inconsistencies that lead to credentialing delays and compliance risks. By reducing errors in application assessments, healthcare organizations can mitigate liability risks and reduce costs for providers.
- near real time reporting: agentic AI to automate data checks, trigger instant alerts, update dashboards live, and route tasks smartly. Add predictive analytics for anomalies, real-time audit trails for compliance, and integrate reporting with team communication tools—ensuring efficient and transparent operations that keep improving over time
- data analytics & insights: identify anomalies, predict delays, and benchmark performance, enabling faster, data-driven decisions. Include compliance tracking and instant alerts for credential expirations or issues, ensuring audit readiness. Integrate insights into team communication channels to keep stakeholders informed, enhancing efficiency, accuracy, and strategic management of credentialing processes.
key benefits of automated provider credentialing
There are several benefits of leveraging automated provider credentialing solutions. Here’s a quick look at a few of them:
- turnaround times shrink from months to days
- reduced manual effort lowers administrative costs and minimizes data entry errors
- built-in checks, balances, and audit trails enhance regulatory compliance and audit readiness.
- continuous monitoring ensures only qualified, verified providers deliver patient care
- improved and accurate claims processing
- improved CSAT scores
looking ahead
Healthcare organizations today face mounting pressure to deliver high-quality care while keeping pace with evolving regulations. With the NCQA shortening the verification window, and the cost of inefficiencies piling up, healthcare providers can no longer rely on traditional credentialing methods.
AI-led digital solutions are becoming a strategic necessity, enabling faster credentialing, reduced errors, and strengthened compliance. With intelligent workflows, real-time integrations, and continuous monitoring, these solutions are transforming credentialing into a continuous, proactive quality safeguard, enhancing patient trust and supporting high-performing healthcare networks.
Forward-thinking leaders recognize credentialing as a strategic lever to drive access, compliance, and competitive advantage in the next era of healthcare.
how can Infosys BPM help
At Infosys BPM, we help healthcare organizations automate and accelerate the credentialing process end to end. Our best-in-class Agentic AI credentialing framework ensures completion of the credentialing process in 15-30 days, powered by AI and data extraction tools that deliver over 90% accuracy for complex provider enrollment forms.
By streamlining workflows, cutting operational costs, and ensuring compliance, we help organizations not only meet regulatory requirements but also improve operational agility and provider satisfaction.
Get in touch to accelerate provider onboarding, strengthen compliance, and transform credentialing into a driver of healthcare excellence.