How Much Does Credentialing Cost? A Full Breakdown for Practices

Credentialing Cost

Credentialing is one of the first steps healthcare providers must complete before they can begin treating patients and receiving reimbursements. It involves verifying a provider’s qualifications, licenses, and professional background, and obtaining approval from insurance companies or healthcare networks to join their panels.

But how much does credentialing cost, and is it worth the investment?

In this article, we’ll break down the different types of fees, compare the costs of doing it in-house vs outsourcing, and explain how the right approach can save your practice time, money, and future headaches.

What Is Healthcare Credentialing?

Credentialing verifies a provider’s qualifications, such as their medical degree, board certifications, state licenses, and work history. It also includes background checks, malpractice insurance verification, and compliance checks with regulatory bodies.

Credentialing is required for:

  • Billing insurance companies
  • Obtaining hospital privileges
  • Complying with state and federal healthcare laws
  • Participating in provider networks

Without credentialing, providers cannot legally or ethically operate in many healthcare settings.

Major Types of Credentialing in Healthcare

Not all credentialing is the same. The costs and processes depend on the type of credentialing involved. Here are the most common types that healthcare professionals should be aware of:

1. Insurance Credentialing

Also known as payer credentialing, this is required for a provider to bill insurance companies for services. This process involves verifying the provider’s qualifications and enrolling them with commercial insurers, such as Aetna, Cigna, and UnitedHealthcare, as well as government programs like Medicare and Medicaid.

What It Involves:

  • Applying to each insurance company
  • Providing documentation like licenses and malpractice coverage CAQH profile completion and maintenance

Average Cost:

  • In-House Processing: $250 to $350 per payer
  • With a Credentialing Company: $250 to $500 per payer
  • With Our Services: Just $200 to $300 per payer

Our team at Pro-MBS offers tailored payer enrollment and credentialing support so you don’t have to navigate this complex process alone.

2. Hospital Credentialing

For providers who want to work within a hospital setting, this type of credentialing is mandatory. Each hospital has its own hospital credentialing requirements, which usually include in-depth background checks, peer references, and interviews with credentialing committees.

What It Involves:

  • Hospital-specific application and forms
  • Verification of clinical history and experience
  • Review by a medical staff office or credentialing committee

Average Cost:

  • $500 to $1,000 per hospital, especially if the process includes additional requirements like privileging
  • Larger institutions may cover some or all of this cost internally

3. Medical Board Credentialing

This type is more of a prerequisite than a recurring credentialing process. Medical board credentialing is the licensing and certification process required to practice medicine in a given state legally.

What It Involves:

  • Passing board exams
  • Submitting transcripts, test scores, and professional history
  • Background checks and fingerprinting

Average Cost:

  • $300 to $1,000, depending on the state and specialty board
  • The license fee is apart from the service charges

4. Delegated Credentialing

Some healthcare organizations choose to delegate credentialing to third parties like medical groups or managed service organizations. These organizations are responsible for verifying and maintaining a provider’s credentials.

What It Involves:

  • Contracts between the payer and the delegated entity
  • Maintaining ongoing credentialing files
  • Following NCQA or URAC standards

Average Cost:

  • Varies by agreement, but can lower long-term operational costs when scaled

Hidden Costs You Shouldn’t Overlook

Beyond the standard fees, credentialing involves several hidden costs that practices often overlook.

Administrative Labor

Credentialing can take up to 20 hours per provider for data gathering, form submissions, follow-ups, and resubmissions. This workload is often spread across billing, administrative, or management staff, diverting time from other critical tasks.

Delayed Reimbursements

If credentialing is not completed on time, providers cannot bill insurance or may face claim denials. This can lead to months of lost revenue. The cost of waiting can be higher than the credentialing fee itself.

Re-credentialing and Maintenance

Credentialing is not a one-time process. Most insurers and hospitals require re-credentialing every 1 to 5 years. Maintaining accurate and up-to-date records is essential to avoid disruptions.

Should You Use a Credentialing Service?

Handling credentialing in-house can be time-consuming and prone to delays. Many practices are turning to professional provider credentialing services to streamline the process.

Benefits of Outsourcing:

  • Faster turnaround times
  • Lower error rates in applications
  • Regular status updates and compliance tracking
  • Reduced administrative burden on staff
  • Cost-effective for growing practices

How to Choose the Right Credentialing Solution

If you’re exploring credentialing options for your practice, here are a few tips to help guide your decision:

Look for Experience in Your Specialty

Credentialing requirements can vary depending on whether you’re a behavioral health provider, physical therapist, or general practitioner. Make sure the service provider has experience working in your specific field.

Ask About Turnaround Time

Delays in credentialing can delay your revenue. Look for a service that offers clear timelines and follows up consistently with payers and institutions.

Ensure Ongoing Support

Credentialing doesn’t stop once you’re approved. Choose a provider who offers monitoring, updates, and re-credentialing support so you stay in good standing over time.

How Pro-MBS Can Help You Simplify Credentialing

Our physician credentialing services help healthcare providers navigate payer enrollment, hospital credentialing, and ongoing maintenance with ease. We work with independent practitioners, clinics, and health systems to ensure your credentials are always current and compliant.

Note: This is a rough quotation to help your practice estimate credentialing-related costs. Please note that final pricing will depend on payer requirements, provider specialty, state regulations, and the complexity of your case.

Service Details & Scope Estimated Timeline Estimated Cost (Per Entity/Payer)
Insurance Credentialing (Commercial & Government) Enrollment with commercial payers (e.g., Aetna, Cigna, UHC) 90–125 days $200 – $500
Re-Credentialing / Revalidation Re-application & updates to stay active with payers 60–90 days $150 – $250
Hospital Credentialing & Privileging Application, documentation review, committee liaison 90–180 days $500 – $900
Group or Facility Setup Register group NPI, TIN setup, link to payers 90–120 days $300 – $450
Medicare Enrollment (PECOS System) New provider/group enrollment or revalidation 60–120 days $250 – $400
Medicaid Enrollment State-specific application and submission 90–120 days $250 – $400
Add Provider to Group Contracts CAQH update, payer applications, linking new providers under group NPI 60–90 days $200 – $300
Delegated Credentialing Setup/Support Policy creation, credential file maintenance, and audits (for MSOs, IPAs) Custom timeline Custom Pricing
Ongoing Credentialing Maintenance Monitoring expiration dates, CAQH, reminders, updates Ongoing $75 – $150/month
Credentialing Audit / Compliance Review Audit existing credentialing status and gaps 5–7 business days Free (Basic Report)

Why Choose Pro-MBS

  • Over 10+ years of experience in medical credentialing across 50+ specialties
  • Dedicated account managers and real-time application tracking
  • In-house compliance review and CAQH monitoring
  • Support for solo practices, groups, hospitals, and MSOs

Interested in a Custom Quote?

Let’s identify what you need and send a tailored proposal within 24 hours.

Conclusion

Credentialing is a must-have step for every healthcare provider, but the associated costs can vary widely depending on the type and scope. From insurance credentialing to meeting hospital credentialing requirements, understanding what applies to your situation is the first step toward building a stable and successful practice.