10 Common Medical Credentialing Errors and How to Fix Them

Medical credentialing encompasses more than just checking a box when it comes to revenue, compliance, and reputation. It serves as your base. However, far too many healthcare organizations, clinics, and physicians continue to make expensive errors that jeopardize licenses, delay reimbursements, or invite audits.

Whether you're a solo BCBA, mental health provider, physical therapist, or an entire behavioral health clinic, mastering the details of credentialing, recredentialing, and therapist insurance enrollment is essential.

Let’s break down the most common credentialing mistakes providers make and explore simple ways to fix them before delays happen.

Neglecting Complete Primary Source Verification

Skipping proper PSV leads to inaccuracies in provider data. In fact, 52% of physicians say patients face monthly insurance coverage issues due to incorrect credentials.

Why it happens: Clinics rely on outdated data or miss checking directly with licensing boards, medical schools, or employers.

How to Fix It

• Use automated Primary Source Verification (PSV) tools to reduce manual errors and save time.

• Maintain a PSV checklist during every credentialing and recredentialing cycle to stay organized and compliant.

• Plan quarterly revenue-raising audit to ensure provider data is accurate and catch issues early.

• Skipping PSV is risky—credentialing without it is like prescribing without a diagnosis.

• Make PSV a consistent part of your credentialing process to protect reimbursements and avoid approval delays.

Incomplete or Incorrect Application Data

85% of credentialing applications get delayed or denied due to missing or outdated information—a typo in your NPI, a wrong license number, or a blank field can cost you months.

How to Fix It

• Use standardized templates for all credentialing and recredentialing forms to avoid formatting errors.

• Train your admin staff to double-verify crucial fields like NPI, DEA, and license numbers before submission.

• Run pre-submission audits with an ABA credentialing specialist or a reliable third-party credentialing service.

• Keep form details consistent across all documents—just one mismatch can lead to automatic rejection.

• Update provider information regularly to ensure accuracy before each submission cycle.

Missing or Expired Documentation

A license that lapsed, expired malpractice coverage, or an outdated CAQH profile can derail everything. One in three practices experiences a 30–45 day delay because of missing documents.

How to Fix It

• Create auto-reminders for licenses, insurance policies, and CAQH updates

• Use cloud-based folders with labeled document timelines

• Conduct quarterly documentation audits

Understaffed or Untrained Credentialing Teams

Around 85% of clinics still manage credentialing internally, even if their staff isn’t trained in payer requirements or compliance. This often leads to errors, delays, and missed revenue opportunities—making professional credentialing support a smarter move.

How to Fix It

• Partner with ABA credentialing companies for therapists or outsource to an ABA credentialing services provider

• Cross-train at least two staff members per credentialing task

• Hold monthly payer-specific policy review meetings

Ignoring State/Payer-Specific Rules

Therapist credentialing isn’t universal—payer-specific and state-specific rules create frequent roadblocks. Rejections often come from missing nuances in policies that vary across regions and insurance networks. What works in one state or with one payer won’t always apply elsewhere.

Here’s how to fix it

• Create a compliance matrix that lists the conditions for every state and payer.

• Review and update the matrix regularly, especially when payers revise policies.

• Assign a dedicated compliance monitor to track changes and keep credentialing aligned.

Every payer has its own language and process. If your team can’t translate those expectations into clean, compliant submissions, delays and denials will keep piling up. Stay proactive to avoid the fallout.

Slow Response to Verification Requests

Credentialing isn’t quick—it usually takes 90 to 120 days. When you rush it, mistakes creep in. Start too late, and you risk revenue gaps and delayed provider start dates. Many ABA practices fall into this trap, especially when scaling.

Here’s how to fix it

• Start BCBA credentialing at least 4–6 months before a new provider's start date.

• Make credentialing a part of your SOP for provider onboarding.

• Use a rolling credentialing calendar to track expirations, updates, and deadlines.

Neglected CAQH Profiles

One of the most common credentialing delays? Outdated or expired CAQH profiles. Even a small inconsistency—like a missing license update or an outdated insurance certificate—can pause the entire process. Many providers forget that payers pull data directly from CAQH, and if it’s not current, applications get stuck.

Here’s how to fix it

• Update your CAQH profile quarterly, or immediately after any change in license, practice location, or insurance.

• To prevent gaps and maintain current records, set CAQH reminders.

• Keep all supporting documents current and uploaded—no gaps, no hold-ups.

• Staying credentialed starts with staying visible and verified. Don’t let a neglected CAQH profile delay your payer approvals.

Missing or Incorrect TIN/NPI Numbers

Missing or incorrect Tax Identification Numbers (TIN) or National Provider Identifiers (NPI) are a leading cause of credentialing rejections. Even a single digit off can trigger a denial or delay payments. These numbers are how payers track and validate your practice—if they’re wrong, everything stalls.

Here’s how to fix it

• Double-check every form and attachment for TIN and NPI accuracy before submission.

• Update all payer systems immediately if your TIN or NPI changes.

• Train your team to verify this information during onboarding and recredentialing.

Failing to Report Adverse Actions (NPDB/OIG)

Failing to report adverse actions listed in the National Practitioner Data Bank (NPDB) or Office of Inspector General (OIG) can derail your credentialing fast. Over 80% of credentialing teams say missing or undisclosed sanctions are a top reason for stalled or denied enrollments. If it shows up in a background check and wasn’t disclosed—contracts may be canceled.

How to fix it

• Perform OIG and NPDB checks at each cycle of new enrollment and recredentialing.

• Flag any issues immediately and respond with full transparency.

• Document resolutions carefully to protect your practice during audits.

Neglecting Ongoing Re-credentialing & Monitoring

Credentialing isn’t a one-and-done task—it’s an ongoing responsibility that requires regular updates to stay compliant and keep providers active. Your practice may suffer significant consequences if you miss a recredentialing date. Delays can actually cost a provider $7,500 in lost income every day, particularly if the provider stops being active in payer systems. Missed tracking is typically the issue rather than denial. 

How to fix it

• Recredential every 2–3 years, based on each payer’s specific timeline.

• Set alerts at least 6 months in advance to prep documents and avoid last-minute scrambles.

• Link recredentialing to payroll or EHR workflows so it stays visible and never falls through the cracks.

Comparison Table: In-House Credentialing vs. Outsourced Services

Feature	In-House Credentialing	Outsourced Credentialing Services
Speed	Slow (90–180 days)	Fast (60–90 days avg)
Accuracy	Risk of human error	QA checks, automation tools
Cost	Hidden payroll + training	Predictable monthly cost
Staff Burden	High (multiple touchpoints)	Low (single point of contact)
Best For	Solo providers	Growing therapy clinics

Best Practices to Prevent Credentialing Errors

Credentialing delays often come down to missed deadlines, disorganized documents, and lack of process clarity. Here’s how to avoid that:

Technology Solutions

• Use credentialing software to track requirements, expiration dates, and submission timelines.

• Set up automated alerts for missing documents or upcoming credential expirations.

• Maintain a consolidated digital document library to help your team stay organized and rapidly locate credentials.

Staff Training and Accountability

• A credentialing professional with knowledge of payer regulations and compliance should be assigned.

• Provide regular training and updates on changing regulations and payer expectations.

• Build accountability checks to make sure credentialing tasks don’t fall through the cracks.

Process Standardization

• Put detailed instructions for each credentialing task in writing.

• Use templates for applications and supporting documents to ensure consistency.

• Add quality control checkpoints to catch errors before they cause rejections.

Solid systems keep your provider credentialing process accurate, compliant, and stress-free.

FAQ

1.How often do providers typically need recredentialing?

Most payers require provider recredentialing every 2 to 3 years. It’s essential to track each payer’s timeline, update documents early, and avoid missed deadlines that could lead to payment delays or removal from insurance panels.

2.How to prevent credentialing denials?

To avoid credentialing denials, double-check all forms for accuracy, keep CAQH and licenses up to date, and follow each payer’s rules. Using credentialing software and having a trained team helps reduce mistakes and missed steps.

3.What are the benefits of medical credentialing?

By ensuring that clinicians fulfill payer requirements, medical credentialing enables them to serve patients and bill insurance. It builds trust with payers, protects revenue, reduces claim denials, and keeps your practice compliant with healthcare regulations.

Conclusion

Avoiding credentialing mistakes takes more than good intentions—it needs structure, tools, and trained people. When healthcare organizations treat provider credentialing as a strategic, ongoing process, they reduce delays, protect revenue, and improve payer relationships. Staying current with policies and regulations is key to keeping credentialing smooth and sustainable.

Let expert ABA credentialing specialists or credentialing services for therapists handle the paperwork, policy updates, payer negotiations, and compliance monitoring.