Credentialing is no longer a periodic administrative task. Credentialing delays are slowing provider onboarding, increasing compliance exposure, and straining member satisfaction. Additionally, the new NCQA standards require continuous monitoring, faster response times, and stronger audit readiness that has turned credentialing into a monthly proof-of-control.
Yet many healthcare payers still rely on manual workflows, fragmented systems, or legacy platforms that can’t scale to meet today’s compliance and access demands. The result:
- Delayed provider onboarding
- Higher administrative costs
- Provider and member dissatisfaction
- Increased audit and compliance risk
This playbook outlines how payers can modernize credentialing operations with AI, automation, and four proven credentialing models, from in-house optimization to fully managed BPaaS and shared-service approaches, and helps payers determine the right path forward.
What You’ll Learn
- Why credentialing delays hurt compliance, revenue and member satisfaction
- How new NCQA requirements change credentialing economics
- The pros and cons of four credentialing models
- How automation and AI along with credentialing models reduce cycle time, credentialing costs, and meet compliance needs
- When outsourcing credentialing delivers better outcomes than inhouse (manual) and homegrown credentialing software
