When Growth Outpaces Your Credentialing Capacity
An Ops and Compliance View of How Growth Affects Credentialing
By Praveen Khanna, Sr. Director Strategic Solutions, Catalyst Solutions
Every population health organization wants the “problem” of growth—a new health plan contract, an expanded service area, a wave of physician group acquisitions. What fewer organizations plan for is what that growth does to credentialing.
Credentialing is usually treated as back-office administration: paperwork that happens after the real decisions (which markets to enter, which groups to acquire, which providers to bring on) have already been made. But credentialing capacity doesn't scale automatically with network growth, and when it falls behind, the consequences show up in places leadership doesn't expect—network adequacy filings, claims payment, and provider satisfaction.
The Blind Spot
The pattern we see most is an organization expands its multi-state provider network (new markets, new plan contracts, acquired groups bringing their own rosters of MDs, DOs, PAs, and NPs) and the credentialing team, already sized for the old volume, quietly falls behind. Nobody decided to underinvest in credentialing, it just wasn't part of the growth plan. A few months later, what started as a manageable queue has become a backlog of hundreds or even thousands of files awaiting initial credentialing or recredentialing, and the operational risk has grown with it.
This isn't hypothetical. We've worked with a national population health organization focused on Medicare Advantage that hit exactly this wall. Rapid network expansion left its credentialing team, already stretched thin, with a backlog of nearly 1,000 provider files which spanned multiple states and provider types. Clearing it took a dedicated team of outside credentialing specialists working focused, full-time sprints for several weeks on verification, packet assembly, and exception tracking—all feeding back to the client's own credentialing committee for final approval. What's telling is what happened next. The engagement didn't end with the backlog but turned into an ongoing, multi-year partnership covering credentialing, recredentialing, and continuous monitoring across the organization's full network. The backlog was a signal that credentialing needed to be resourced as an ongoing operational function, not a project.
Why the Margin for Error Has Shrunk
This blind spot is riskier today than it was a few years ago, for two reasons. First, the standards have gotten tighter. As of July 2025, The National Committee for Quality Assurance (NCQA) reduced its primary source verification window from 180 days to 120 days for credentialing accreditation, and to just 90 days for credentialing certification, with license-expiration tracking now required monthly and exclusion/sanction checks every 30 days(1). A backlog that used to be merely inconvenient can now put an organization out of compliance.
Second, the connection to network adequacy is direct, not theoretical. Under The Centers for Medicare & Medicaid Services (CMS) guidance, a Medicare Advantage plan can only count a provider as in-network once that provider is fully credentialed and contracted; interim or "in process" status doesn't count on Health Service Delivery (HSD) tables(2,3). When credentialing timelines stretch past roughly 90 days, the result is an appointment-access gap even when a plan's provider directory looks complete on paper. The credentialing queue, in other words, isn't just an internal workflow metric; it is load-bearing for regulatory compliance and member access.
From a broader industry perspective, credentialing delays are now widely cited as a bottleneck slowing healthcare hiring at a time when workforce shortages are pushing organizations to bring on clinicians faster. So, it's easy to see why credentialing capacity deserves a seat at the table when growth is being planned.
Signs Your Credentialing Operation is Behind Your Growth Curve
A few practical signs worth watching for:
Initial credentialing routinely runs past 90 days or recredentialing past 60 (the general benchmarks most operations teams target).
Growth decisions (new markets, new contracts, acquisitions) get made without a parallel conversation about credentialing capacity.
Your team can tell you the backlog exists but not how it's trending (file counts without week-over-week velocity).
Recredentialing and monitoring compete for the same stretched staff as initial credentialing, so one always loses.
The Takeaway
A credentialing backlog is rarely a staffing problem in isolation. It's usually a symptom of growth that outran the operational plan supporting it. Organizations that treat the fix as temporary surge support tend to be back in the same spot at the next growth milestone. The ones that treat it as evidence that they need durable, scalable credentialing capacity, whether built internally or through an ongoing partner, are the ones who stop firefighting the backlog and start staying ahead of it.
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