Inside Credentialing: Insights from Our Experts
Credentialing is a vital yet often overlooked aspect of healthcare administration. It determines whether providers can offer services to patients under insurance plans, impacting access to care and the financial well-being of medical practices. However, the process is intricate, varies by payer, and often takes months to complete. To shed light on the complexities of credentialing and offer practical strategies, we recently sat down with two of our seasoned experts—Olga Khabinsky and Alina Mineyli.
The Expertise Behind the Process
Olga, the Director of Operations at WCH and a credentialing specialist with years of experience in provider enrollment and insurance negotiations, teamed up with her colleague Alina, a senior credentialing specialist. Together, they have helped countless providers navigate the ever-evolving world of payer regulations, ensuring that practices stay compliant and credentialing applications move forward efficiently.
“Our work goes beyond just paperwork,” says Olga. “Credentialing is about strategy, persistence, and relationship-building. It’s knowing when to follow up, how to interpret payer instructions, and when to escalate issues to the right people.”
Alina echoes this sentiment, emphasizing the importance of precision. “Missing one small detail—whether it’s an outdated CAQH profile or an incomplete signature—can delay the entire process by weeks or even months. That’s why tracking and planning are crucial.”
Tracking Credentialing the Right Way
One of the biggest pain points in credentialing is application tracking. With different payers using different methods—some requiring phone calls, others relying on online portals—there’s no one-size-fits-all approach. According to Alina, the key is understanding each insurance company’s specific requirements and following their instructions carefully.
“When a provider submits an application, they receive guidelines on how to check the status,” she explains. “Some payers provide online updates, while others require direct outreach. It’s important to document every step, every call, and every email to ensure nothing falls through the cracks.”
Olga adds that credentialing specialists who are new to the field or providers handling their own applications should pay close attention to these instructions. “You have to develop a system for tracking. Whether it’s a detailed spreadsheet or a project management tool, keeping organized records is what separates successful credentialing processes from ones that drag on indefinitely.”
The Power of Relationships
While technical knowledge and organization are essential, relationships with payer representatives play a significant role in credentialing success. Over the years, Olga and Alina have built strong connections with provider relations teams, network managers, and insurance representatives—relationships that often help move applications forward when delays occur.
“Having a good rapport with the right people at an insurance company can make all the difference,” Olga says. “They can give you insider information on processing timelines, upcoming committee meetings, and even which specialties a payer is actively looking to add to their network.”
This networking advantage allows credentialing specialists to offer additional value to their clients. If an insurance company is actively seeking certain specialties in specific regions, providers can position themselves more strategically when applying.
What Happens When Credentialing Delays Occur?
Delays are an inevitable part of credentialing. While many providers expect the process to take around 90 days, some applications stretch to 120 days or longer, especially with large insurers like Blue Cross Blue Shield and UnitedHealthcare.
“When this happens, persistence is key,” Alina advises. “Regular follow-ups, escalating cases to higher management, and even filing formal complaints if necessary can help move things along.”
Another crucial step is leveraging state-level oversight. “Every state has a Department of Insurance or a healthcare regulatory body that sets credentialing timelines,” Olga explains. “If an application is stuck beyond 120 days with no updates, providers have the right to escalate the issue to these regulatory agencies.”
Looking Ahead: Smarter Credentialing
At its core, credentialing isn’t just a bureaucratic hurdle—it’s a fundamental part of ensuring healthcare providers can serve their patients without interruption. As insurance companies continue to refine their processes and new technology solutions emerge, the future of credentialing may involve more automation and transparency.
For now, however, the best approach remains a combination of diligence, organization, and relationship-building. As Olga and Alina’s experience shows, credentialing isn’t just about submitting paperwork—it’s about understanding the system, anticipating challenges, and using strategic thinking to navigate the process effectively.
If you’d like to learn more about credentialing best practices, check out our latest discussion with Olga and Alina. You can find the full conversation on our LinkedIn page at the link below.
