Credentialing Denials

Have These Mistakes Lead to Credentialing Denials?

The foundation of efficient optimized medical billing and revenue cycle management is proper credentialing. Verifying a provider’s credentials is a tedious and time-consuming task, but it is also one that must be handled properly and accurately to ensure cash flow.

This article will explore a couple of common issues that may lead to credentialing denials.

Allocating Proper Resources

Credentialing requires attention to detail and patience. Every care provider including doctors, nurse practitioners, and therapists all require credentialing.

This process verifies their entire care-giving history and certifications in their specialty.

Simple math shows us that the larger your practice, the more care providers and the larger the credentialing load. Not providing sufficient staff to handle this process accurately, may be the most common error. Overwhelming amounts of data can cause a great deal of stress and frustration which can lead to errors. These errors lead to denials, delays and lost revenue.

Incomplete and Incorrect Documents

Errors cost time and money. Every practice strives for mistake-free provider enrollment applications, but inevitably they do happen. Incomplete documentation is an easy mistake to make, especially in practices that operate with a lean staff that handle multiple responsibilities. Typos and other clerical errors are bound to happen. Therefore, proper coding and correct data are essential.

The volume of patients in the long-term care and the post-acute space is growing and with it the importance of accurate credentialing.

If you’ve found that you and your team are frustrated by denials, your practice must improve its process. Outsourcing is one method to effectively address these issues. Saisystems Health offers services dedicated to initial and ongoing enrollment with payors, which will improve your practice’s ability to effectively bill and collect from insurance companies.

Individual and group practices can benefit from:

  • Reduced administrative workload
  • Enrollment and renewal management and tracking
  • Eliminated payment interruption
  • Reduced credentialing delays
  • Regular payments through electronic funds transfers

For more information contact Saisystems Health at 203-929-0790 or email

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