The 2025 Credentialing Crisis: Why Medical Groups Must Modernize Now
In 2025, one of the most overlooked emergencies in healthcare is not clinical, financial, or technological—it’s administrative. Specifically, the U.S. is in the middle of a full-scale credentialing and provider enrollment crisis that is silently cutting revenue, delaying hiring, blocking patient access, and overwhelming medical groups that aren’t built to handle the new regulatory landscape.
Across hospitals, telehealth organizations, SNFs, FQHCs, behavioral health networks, and specialty practices, leaders are discovering that what used to take 60–90 days can now take 120–180 days or more. Many are stunned to find that the processes they relied on for years no longer work—because the healthcare environment has changed at a structural level.
Medical credentialing has never been simple, but in 2025, it’s reached a point where traditional workflows cannot keep up. Rivon Health has been tracking and responding to this trend in real time across all 50 states—and the conclusions are clear: the industry must evolve or face years of operational and financial disruption.
Below is a deep dive into why the crisis is happening, how it is impacting medical groups, and what organizations must do immediately to protect revenue and keep providers working.
Part 1: What Caused the 2025 Credentialing Crisis?
1. State Medical Boards Are Overwhelmed
State boards have seen a dramatic increase in licensing volume due to:
Telehealth expansion
Multi-state medical groups
Growth in locum tenens
Provider turnover post-COVID
Interstate compact participation
Many boards are operating with outdated technology, manual verification processes, and insufficient staff. Some states have reported licensing backlogs of 3–6 months, with no signs of improvement.
2. Payers Have Increased Fraud-Prevention Requirements
Insurance payers—Medicare, Medicaid, commercial plans—have tightened verification standards due to rising fraud, identity discrepancies, and improper enrollment. Common new requirements include:
Additional primary source verification
Mandatory digital identity authentication
More frequent CAQH re-attestation
Longer review cycles
Additional proof of practice locations
Re-validation of taxonomy codes, TINs, and NPIs
These guardrails protect the industry but add weeks of processing time.
3. Medicare & Medicaid Delays Are at Record Highs
PECOS enrollment, revalidation, and changes of information (COIs) have become slower due to:
Staffing shortages
Increased audit volume
New validation protocols
Higher documentation standards
Some MACs (Medicare Administrative Contractors) now routinely take over 60–90 days for enrollments that once took 30–45.
4. Commercial Payers Have Shifted to Hybrid or Remote Teams
Post-pandemic staffing transitions hit payer credentialing teams hard. Many now rely on:
Outsourced teams
Rotating remote staff
Low-volume call centers
Slower response times on email and uploads
This has created inconsistent communication and unpredictable processing timelines.
5. Compliance Rules Change Frequently, Often Without Notice
Payers and state boards update requirements often—and inconsistently. A form required last year may be outdated today. A notary requirement may suddenly appear. A state may announce a new background check requirement with no grace period.
For medical groups without expert monitoring, this creates constant resubmissions, rejected applications, and preventable delays.
Part 2: The Impact on Medical Groups (The Financial Shock No One Planned For)
1. Providers Can’t Bill—Revenue Losses Are Enormous
Every day a provider is not credentialed is a day they cannot generate revenue.
For practices, this means:
Empty provider schedules
Lost encounters
Delayed reimbursement
Unbillable claims
Cash flow unpredictability
For providers, this means:
Delayed start dates
Reduced earning potential
Inability to prescribe or order tests
Loss of confidence in their employer
Many facilities underestimate the cost. A single uncredentialed provider can cost a group $30,000–$150,000 per month, depending on specialty.
2. Hiring Delays Hurt Competitive Advantage
A bottlenecked credentialing department:
Slows provider onboarding
Loses candidates to faster-moving competitors
Creates operational frustration
Damages reputation
In a market with provider shortages, speed is a major competitive differentiator.
3. Workflows Break Down When Multiple Systems Don’t Align
Most practices use a mix of:
Spreadsheets
Email threads
Scanned PDFs
EHR credentialing modules
CAQH
Private payer portals
Medicare PECOS
Credentialing vendor portals
When these systems don’t sync, it causes:
Duplicate work
Errors
Missing documentation
Lost communication
Misaligned timelines
This chaos results in applications that are incomplete or incorrect—payers reject them, and the clock resets.
4. Compliance Risk is Higher Than Ever
Poor credentialing can trigger:
Payer audits
Contract termination
Retroactive denials
Sanctions
Medicare revocation
Civil penalties
The cost of noncompliance is far greater than the cost of doing credentialing right.
Part 3: Why Traditional Credentialing Structures Fail in 2025
Most medical groups still rely on outdated structures:
One credentialing person handling everything
Email-based communication
Paper files or static checklists
Slow CAQH updates
Lack of visibility for leadership
No centralized tracking system
Manual follow-ups with payers
This worked 10 years ago, but today it’s a blueprint for failure.
The Old Model:
Reactive
Manual
Slow
Error-prone
Dependent on one or two employees
The New Model (What Modern Groups Use):
Automated reminders
Real-time dashboards
Parallel licensing + credentialing processes
Standardized documentation
Outsourcing to expert credentialing partners
Compliance-driven workflows
Audit-ready verification processes
In the new environment, speed, accuracy, and tracking are not luxuries—they are operational necessities.
Part 4: How Medical Groups Can Modernize Now
1. Start Credentialing the Moment an Offer Letter is Signed
Organizations that wait until a provider completes onboarding paperwork lose weeks.
Modern groups start immediately—sometimes before the contract is even finalized.
2. Move to a Centralized Digital Credentialing Hub
All documents, expirables, forms, and communication should be tracked:
In one system
Accessible by all relevant team members
With clear deadlines
With automated alerts
This eliminates lost emails, outdated attachments, and confusion.
3. Conduct a Complete Pre-Submission Credentialing Audit
Before any application is submitted, Rivon Health recommends reviewing:
NPDB reports
CAQH accuracy
Work history
Malpractice coverage dates
Background check requirements
Name change documents
Secondary addresses
NPI and TIN validity
This alone prevents 30–40% of credentialing delays.
4. Parallel Process Licensing and Enrollment
Don’t wait for licensing to finish before beginning payer prep.
Modern workflows run both simultaneously wherever rules allow.
5. Use Credentialing Experts Instead of Generalists
As requirements become more complex, credentialing is no longer an admin task—it’s a compliance specialty.
Partnering with an expert team like Rivon Health allows groups to:
Avoid rejections
Communicate directly with payers
Navigate Medicare & Medicaid efficiently
Track all states simultaneously
Maintain perfect documentation
This is how organizations gain speed, accuracy, and stability.
Part 5: The Future of Credentialing (What’s Coming in 2026 & Beyond)
Rivon Health monitors national trends, and several shifts are emerging:
1. Digital Identity Verification Will Become Mandatory
Within 2–3 years, most state boards and payers will require:
Biometric verification
Digital identity checks
Updated authentication systems
2. More States Will Join Interstate Licensing Compacts
Accelerating multi-state practice is a top national priority.
3. Delegated Credentialing Will Become Standard for Large Groups
Organizations that don’t transition will be left behind.
4. Credentialing Automation Will Replace Manual Work
AI-assisted verification and document parsing will become widely adopted.
5. Compliance Audits Will Increase
Payers will demand more transparency and verification from practices.
Organizations preparing now will avoid disruption later.
Conclusion: 2025 Is the Turning Point — Modernize or Fall Behind
The credentialing crisis is not temporary—it is a structural shift in healthcare administration.
Medical groups that cling to outdated processes will face:
Delays
Lost revenue
Provider frustration
Compliance consequences
Groups that modernize will gain:
Faster onboarding
Predictable revenue
A competitive hiring advantage
Stronger compliance frameworks
Better provider satisfaction
Rivon Health is positioned to lead this shift, supporting organizations with the expertise, workflows, and systems needed to survive—and thrive—in the new credentialing era.