Why DIY Credentialing Is Risky: Real Stories from Medical Practices

When expanding a practice or onboarding new providers, many healthcare organizations are tempted to “do it themselves” (DIY) when it comes to credentialing and payer enrollment.

At first glance, DIY credentialing seems cost-effective—why pay a credentialing company when your internal team can handle it?
But as many practices have learned the hard way, DIY credentialing often leads to errors, denials, revenue loss, and compliance risks that can cost far more than outsourcing to experts.

In this article, we’ll explore real-world stories of medical practices that tried to manage credentialing in-house, the challenges they faced, and how partnering with Finnastra turned things around.

The Credentialing Process: Why It’s More Complex Than It Looks

Provider credentialing isn’t just paperwork. It’s a highly regulated process with serious financial and compliance implications. Each payer has unique requirements, timelines, and verification steps.

According to the Medical Group Management Association (MGMA), credentialing errors are among the top three causes of claim denials, and 80% of denials are preventable with proper processes in place.

Here’s why DIY credentialing is inherently risky:

• Complicated Payer Requirements: Medicare, Medicaid, and commercial insurers all have different forms, steps, and deadlines.
• Long Timelines: Initial credentialing takes 90–120 days, with delays extending that to 150+ days if errors occur.
• Revenue Impact: A single uncredentialed provider can cost a practice $7,000–$10,000 per week in lost revenue.
• Regulatory Compliance: Mistakes can trigger audits or even expose practices to fraud investigations.

Real Story #1: A Small Practice Loses $180,000 in Six Months

A three-provider behavioral health practice in Texas decided to handle credentialing internally to “save money.” Their office manager submitted payer applications manually, assuming it would be straightforward.

What went wrong:

• Two applications were rejected because the CAQH profiles weren’t properly updated.
• Medicaid enrollment was delayed because of missing supporting documents.
• The team didn’t track re-credentialing dates, resulting in one provider being unexpectedly removed from two payer networks.

The impact:
The practice went six months without being reimbursed for services provided by one provider, resulting in $180,000 in lost revenue. Frustrated and overwhelmed, they turned to Finnastra for help.

The solution:

• Finnastra immediately audited all pending applications and corrected errors.
• We established a centralized tracking system to prevent future lapses.
• Within 45 days, all three providers were fully credentialed and actively billing again.

Key takeaway:
Trying to save a few thousand dollars in credentialing fees ended up costing the practice six figures in lost revenue.

Real Story #2: Telehealth Startup Delayed by Four Months

A fast-growing telehealth company was expanding into five states. They attempted to manage over 200 payer enrollments using their internal admin team.

The challenge:

• Different state Medicaid rules created confusion.
• Commercial payers had conflicting requirements for telehealth services.
• The team lacked the expertise to negotiate fair reimbursement rates.

The result:
Their planned launch date was delayed by four months, costing the company nearly $500,000 in missed billings and creating reputational damage with investors and new hires.

How Finnastra helped:

• We streamlined all credentialing workflows and reduced turnaround time by 30%.
• Our insurance contract negotiation services secured reimbursement rate increases averaging 12% across key payers.
• A credentialing dashboard gave executives real-time visibility into progress.

The Hidden Costs of DIY Credentialing

When organizations try to manage credentialing in-house, the true costs often go far beyond staff salaries.

Risk Area	Financial Impact
Credentialing delays	$7,000–$10,000/week per provider
Incorrect submissions	30–60 extra days per application
Missed re-credentialing deadlines	Loss of network participation, weeks of non-payment
Poor contract negotiation	10–20% lower reimbursement rates

These risks compound as practices grow, making scalable credentialing support essential for long-term success.

Why Finnastra Is the Trusted Solution

When you work with a dedicated Provider Credentialing and Contract Negotiation Services partner like Finnastra, you eliminate the stress and uncertainty of DIY credentialing.

Our comprehensive approach covers every step:

• End-to-End Credentialing Management: From initial applications to ongoing re-credentialing.
• Payer-Specific Expertise: Deep knowledge of Medicare, Medicaid, and commercial plans across all 50 states.
• Contract Negotiation: We fight for better rates so you get paid what you deserve.
• Compliance Safeguards: Protecting your organization from costly audits and penalties.
• Real-Time Tracking: Dashboards that keep you informed at every step.

As a leading Provider Credentialing and Contract Negotiation Services company, Finnastra ensures that your providers are credentialed accurately, efficiently, and profitably.

Key Questions for Healthcare Executives

Before choosing a DIY credentialing path, ask yourself:

• How much revenue are we losing each week due to credentialing delays?
• Do we have the expertise to navigate state-specific and payer-specific rules?
• Are our current payer contracts optimized for maximum reimbursement?
• Who is monitoring re-credentialing deadlines to prevent sudden network terminations?

If you’re uncertain about any of these, it’s time to bring in an expert.

Partner with Finnastra and Protect Your Revenue

DIY credentialing might seem cost-effective initially, but the hidden risks and long-term financial consequences are simply too high.

Our Provider Credentialing and Contract Negotiation Services are designed to simplify every step of the process, so you can focus on delivering care while we protect your revenue and compliance.

Contact Finnastra today to schedule a credentialing consultation and discover how we can help you scale with confidence.
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