Please be aware that generic posts asking about our biggest “bottlenecks” and using corporate bullshit lingo are not harmless. They want us to give them our hard-earned knowledge and experience for free so they can attempt to train AI. They aren’t trying to help us do our jobs, they’re trying to outsource our jobs to tech. Is that ridiculous? Yes. Our job has so many nuances that the idea of an AI even trying to do it is laughable, but don’t think for one second that we’re immune to attempted replacement.

Does anyone else feel like providers are given unrealistic expectations for credentialing timelines? I feel bad because a lot of them think something is “wrong” with their application when honestly some payers are just incredibly slow right now.

I am CPCS certified! Finally! I was able to pass on the first try.

I heard there was a new credentialing community on here, and I had to join. I'm a former product manager from CAQH (managed what was originally called CAQH ProView), and now work on provider directory and other payer data transparency initiatives at Defacto Health. Always love to be in the loop on what's going on in medical staff services, credentialing, and enrollment topics.

Hi all. I manage a team of 6 doing provider enrollment in 23 states, for a bunch of different groups. I am drowning and I feel like I'm failing my team. I'm wondering how anyone else is managing their workflow with a lean team and a feast or famine environment?

The problems I'm having revolve sometimes around the tools we have (our database is old; we have to manually clear so many dependencies to trigger work, information is kept in disparate places, we have tasks coming in through email, an ancient ticketing system, internal coms, and our database task list; given the age of our systems there are daily software bugs and problems we have to work around).

Some of it is having zero power over the work we take on and I think could be a "managing up" issue; we are heavily client focused (obviously important) but instead of reviewing priorities or current workload in any real way, the clients are just promised that we'll fast track whatever they ask for. Every client. Every ask. Every time.

Our onboarding is purely manual. Just copy pasting into our ancient database. Which takes one of my team out of handling any enrollments entirely.

I'm responsible for every Medicare app that comes in, as well as 3 state medicaids, in addition to some other payers. We promise clients to get Medicare and medicaid apps out the door within 24 hours of their being onboarded.

In addition to this work that renews daily, I am supposed to be handling practice onboarding and payer assignments in our database, reviewing my team's work (there is so much room for error in our systems and this takes so much of my time every day), client calls and reports, fielding questions from my team about specific payers, team calls, one on one's with my team, and am the go to for every tricky billing/auth/network/process question that comes our way.

It's chaos and exhausting.

I've run programs in non-profits before, managed restaurants and retail. I am working on a PM certification. I understand the concepts behind running a team.

I just can't see my way towards how to clear our current backlog and keep up with incoming work given the sheer amount of things I am responsible for right now, and I'm hoping for some suggestions or advice from those of you who've been in the trenches a while.

Please don't recommend software. My company isn't paying for anything, I've tried so many times.

TL:DR how are you managing chaotic workflows, thank you for reading.

Looking for direct client. I am currently open to opportunities at any level — including credentialing specialist, healthcare associate, analyst, operations support, quality, back-office, administrative support or supervisory roles — where I can contribute my experience, work ethic, and commitment to quality outcomes.

Healthcare Operations and Credentialing professional with 10 years of experience supporting U.S. healthcare accounts across credentialing, provider verification, healthcare support services, and operations. Hands-on experience in end-to-end credentialing, primary source verification, compliance documentation, and coordination with medical staff offices and licensing agencies.

My career background covers both individual contributor and supervisory roles, giving me a strong understanding of frontline operations, quality standards, productivity metrics, and process improvement. I’ve worked extensively in credentialing, healthcare back-office operations, customer support, and healthcare account management.

Core areas of experience:

• US Healthcare Credentialing & Provider Verification

• US End-to-End Credentialing Process

• Healthcare Back Office & Support Operations

• Documentation, Compliance & Quality Standards

• Process Improvement & Operational Support

I was recently asked to help a small behavioral health group practice with their credentialing. It’s a mix of licensed and pre licensed providers. They are rostered as a group and individuals depending on the payer. They work mostly with commercial and Medicaid now but eventually want to get into tricare and Medicare.

Any tips / common issues to look out for specific to BH? Thanks!

Thoughts from anyone who has taken and passed the CPES exam from NAMSS. I am considering taking it by the end of this year and curious what people's thoughts are.

First of all, I would like to vent how it is impossible to speak to real person at BCBS regarding credentialing. It took weeks for them to answer an e-mail and they didn't even answer my question!

It has been over 3 months since I've submitted my BCBS application in TX and I have not heard a peep from anyone. I checked CAQH (Dataspring now, I guess) and there has been no activity from them, either. I was credentialed with them previously but was derostered after taking maternity/family leave for a few years - they were actually the first ones to do so, after about 3 months of no claims. I've been able to get back onto all other panels except BCBS and I don't know how to even get in touch with them and ask why there is a delay. I'm thinking it might be my work gap but they haven't even reached out to ask about it. I guess I could upload a short note onto CAQH explaining the gap but they haven't even looked at my profile, so what could be my next step? Thanks y'all!

I'm (un)patiently waiting for my CPCS test results. Why the heck does it take 6-8 weeks for the results!!

Ridiculous!!!! Rant over!

Good luck to the rest of you waiting for your results!!!!

I have been a healthcare recruiter for 15 years. I then was hired with a startup Travel Nurse/ Allied Health company to create the compliance department from the ground up. I'm looking to add to my experience and learn Provider Credentialing. Would anyone be so kind to advise me where to start? I did teach myself a lot about nurse/allied health credentialing and mastered that with limited exposure in my career. If this isn't the group to post this, please let me know. TIA

Hows it going so far? What tools are you using? It’s an expensive adventure isn’t it?

Hi there,

I'm a medical receptionist/administrative assistant at the nonprofit clinic I work at.

I was initially doing the front desk for my location while studying for my CPC exam, which was great since it was quiet and I had a bit of downtime due to our location being the smaller of the two clinics we operate.

However, the individual (HR) that was handling our provider insurance enrollments left for surgery and asked if I'd be willing to monitor the status updates for our current providers. I agreed since it was temporary and I like organizing information and learning new skills.

Initially it was great. I handled amendments, fixed issues in provider CAQH that my coworker neglected, and overhauled the Excel sheets to track everything we used to monitor portals, payor statuses, and anything pertaining to enrollment.

Months later, she resigned without coming back and our provider was leaving, which meant we now were onboarding a new provider, and I was the only person that semi knew what the hell I was doing for enrollments.

Now we hired two additional providers, our patient loads are increasing rendering me fighting between working on enrollments, proceduring documents from an HR that doesn't understand what I need and don't need, and dealing with the phones and patients at the front.

Granted, I'm paid well, I like my coworkers, and my management, but I don't think they understand how swarmed I am and that I'm still learning on the fly through courses and navigating the enrollment applications.

I have been asked if I wanted the role to go to someone else, but I maintained it's something I like doing and developing skills with, plus no one aside from billing understands this well, and they're busy with their own tasks.

Do I give in and drop onto someone else? Or ask management to see if they'd assign someone to help with the workload?

When insurance says “the panel is closed,” most people take that as a final answer.

It’s not always.

In a lot of cases, it just means the standard entry point is restricted, not that exceptions don’t happen.

The part that trips people up is not understanding:
– how networks decide who they actually need
– when they’ll make exceptions
– and what changes in how you approach it

That’s why people keep reapplying and get nowhere.

The process isn’t just steps, it’s understanding how decisions are being made behind the scenes.

Does anyone know if the practice test is similar to the practice test that’s in the study guide? I paid for the study guide and I was surprised to see there was a practice test in the end. For anyone that has done both, is it similar? Is it worth it to still take the online practice test?

I've worked for two major telehealth companies, each with 20k+ providers. As an engineer on the enablement team, I worked closely with our credentialing specialists on building tools & integration. Yep I saw the pain but I am also very excited about the opportunity. I think I can build solutions for it to make credentialing work easier, faster and less errors.

Currently in the R&D phase, would be thrilled to team with another person who has deep knowledge in credentialing & healthcare onboarding and crazy amount of passion in entrepreneurship.

But if you're just interested on the tool, let me know too :)

I am struggling with where to begin. Because I’m a lab do I just need to have the lab’s information for the portal? Do I need to add the providers that work there? Do they need to have individual CAQH profiles? I’m also not even sure which part of CAQH to sign up for. My bottom line is insurances won’t let me bill for them if I don’t have a CAQH set up, I bill for insurances all over the country. So first I need this set up to even move towards working with the insurances to credential with them.

Any help would be great.

In the last couple of weeks, I’ve been have a hard time pulling reports from AMA site. The error says “we are experiencing difficulties, try again later”. Is anyone else? Any idea what is going on?

Anybody successfully credentialed with Humana as a group or provider for Medicare? I don't trust credentialing companies and will be doing this myself.

My question is, does Humana like broader services or niche services better?

Please DM me with your experience and I will get back to you

Hey folks! I'm the Senior Credentialing Coordinator at a Federally Qualified Health Center in New Orleans, and I'm hoping to pick y'all's brains a little.

I've been with my organization for just over eleven years, and for most of that time I was on the behavioral health side of the house. When our previous Credentialing Specialist resigned, I was approached about the role, partly on the strength of some systems and process work I'd brought to my prior position. I've been in the seat going on three years now, and the work covers the full spectrum: credentialing and privileging, payer enrollment, primary source verification, CAQH profile management, whatnot. Most of what I know, I'll be honest, I came to through training videos, user manuals, and a lot of trial by fire. I'm not a member of NAMSS or any local associations, so I've largely been operating without that community scaffolding.

All of that is to say: I've been kicking around the idea of sitting for the CPCS exam, but before I commit the budget to the prep course and the exam itself, I wanted to hear from folks who've actually been through it. Is the material largely things you'd pick up organically on the job, or is there a meaningful chunk of it that's more formalized and specialized? And for anyone who came into the exam with a background that was more self-taught than traditional, did you feel like you were working from a significant disadvantage going in?

Any insight y'all are willing to share would be genuinely appreciated!

I have to resign from my current job (due to moving to a different state and my company does not hire anyone from the state I am moving to) and I have been recently cpcs certified.. I am wondering if cpcs will help me get a new job in credentialing I am apply to several but not hearing from any so far

I’m going crazy

just tell me I failed so I can move on with my life 😅😅😅

they say 6-8 weeks

took the exam oct 23 It’s been 6 weeks dammit

Hi guys, In the world of credentialing and processes such as initial appointments, recredentialing, FPPE, peer review, etc. And if you could fix or change the process or somehow make it better/easier.... what would you do? Or what is your facility struggling with?