Presented by Cred2Bill

Challenge

Credentialing and payer enrollment delays routinely cost healthcare organizations hundreds of thousands in lost or delayed revenue each year. For hospitals and clinics that depend on timely provider activation, especially in critical access and rural settings, these delays can significantly disrupt billing and cash flow.

Our client, a Colorado Rural Health Hospital, faced a common challenge: ensuring their newly hired Emergency Department Physician was credentialed and enrolled with major payers in time to impact Q4 2025 revenue.

Objective

To demonstrate that when credentialing is handled with precision, proactive communication, and payer-specific expertise, the result is faster approvals and fewer revenue gaps.

Approach

Cred2Bill managed the complete payer enrollment process, focusing on:

• Submitting complete, error-free applications the first time
• Leveraging established relationships with payer representatives
• Tracking each payer’s timeline and response pattern
• Prioritizing audit-ready documentation for compliance and speed

Results

Despite average payer timelines of 60–90 days, the approvals below were obtained in as few as 2–15 days for most payers – a reduction of up to 75% in processing time.

Payer	Status	Effective Date	App Submission Date	Days for Approval
Aetna	Active	9/26/2025	8/19/2025	38
Blue Cross Blue Shield (BCBS)	Active	8/22/2025	8/19/2025	3
Cigna	Active	9/15/2025	8/19/2025	27
Claritev	Active	8/25/2025	8/19/2025	6
Colorado Access HMO	Active	9/15/2025	9/9/2025	6
Health First Colorado (Medicaid)	Active	7/15/2025	7/17/2025	2
Medicare	Active	7/15/2025	6/30/2025	15
Simplified Benefits Administrators	Active	7/15/2025	7/18/2025	3
T-5	Active	7/15/2025	7/23/2025	8
TriWest (VA)	Active	7/15/2025	7/18/2025	3
Midland’s Choice	Resubmitted		8/19/2025
United Healthcare (UHC)	Active	8/21/2025	8/19/2025	2

Impact

The revenue loss per week of credentialing delay for Emergency Medicine providers.

Variable	Example Value	Notes
Encounters per day	12	Typical ED volume per provider
Reimbursement per encounter	$175	Blended payer mix (commercial + Medicare/Medicaid)
Shifts per month	20	About 5 shifts per week
Average shift length	10–12 hours	Standard EM shift

Weekly Revenue Loss Calculation for 1 EM Physician

Delay Duration	Revenue Loss (per provider)
1 week	$10,500
2 weeks	$21,000
3 weeks	$31,500
4 weeks (≈1 month)	$42,000

Delay Duration	Revenue Loss (per NP / PA / APP)

1 week

$8,925

4 weeks

$35,700

By completing enrollments well ahead of the payer norm, the hospital:

• Prevented Q4 revenue loss from non-billable services
• Reduced administrative lag time between hire and billable status
• Improved provider onboarding experience, enabling care delivery without delay

Conclusion

This case underscores how data-driven credentialing directly supports financial performance. When credentialing and payer enrollment are executed with speed, accuracy, and compliance readiness, the result is measurable revenue protection and operational efficiency.

Cred2Bill exists to make that possible.  Turning what’s often seen as an administrative bottleneck into a strategic revenue safeguard.