The Dos and Donts of Provider Credentialing with Insurance Payers: Avoiding Denials, Delays and Lost Revenue

Credentialing has moved beyond paperwork—it's now a high-stakes, high-compliance process that requires precision, follow-through, and technical fluency. In this comprehensive webinar, we will walk you through the most important dos and don’ts of provider credentialing with insurance payers, helping you prevent denials, delays, and costly errors.

We’ll cover the entire lifecycle of credentialing—from new provider enrollment to revalidation, recredentialing, and dealing with terminations. You'll learn how to collect the right documents, clean and submit applications, monitor progress, and escalate when things stall. Just as importantly, we’ll address what not to do—like submitting incomplete packets, failing to attest on CAQH, ignoring follow-ups, or waiting until services are denied to take action.

Special focus will be placed on AI-driven payer systems that now auto-deny applications based on flag triggers—like outdated addresses, multiple group affiliations, social reputation, or claim history. You’ll learn how to monitor red flags, use tools like CredyApp, PECOS, CAQH, and MAC portals, and create a proactive follow-up schedule that ensures nothing falls through the cracks.

This session combines real-world scenarios, industry-backed best practices, and step-by-step workflows from credentialing experts. Whether you’re working in a small private practice, a large facility, or building a credentialing service business, these insights will save you time, money, and frustration.

Learning Objectives:-

• Understand the complete credentialing process from start to finish
• Identify common application errors and how to avoid them
• Implement tracking systems and escalation strategies
• Learn how AI is changing how payers assess applications
• Avoid red flags that trigger automatic denials
• Maintain credentialing for compliance and revalidation
• Know how to escalate issues to supervisors, legal teams, or DOI

Bonus Content:-

• Sample credentialing workflows (10-step process)
• Templates for tracking, escalation, and appeal
• Real-world examples of AI-based denials and how to fight back
• Insights from CMS and Medicaid enrollment errors
• Checklist for clean application submissions.

Areas Covered in the Session:-

The Dos

• Submit complete, clean applications with accurate, current information
• Use tracking tools and document every interaction with payers
• Stay ahead of attestation deadlines (CAQH, PECOS, etc.)
• Follow up every 14–30 days with ticket/reference numbers
• Maintain professional communication with payer reps
• Prepare appeal and escalation templates in advance
• Know how to interpret and respond to denial letters

The Don’ts

• Don’t submit applications with missing documents or expired licenses
• Don’t assume applications are in process without follow-up
• Don’t provide services before credentialing is complete (risk of clawbacks!)
• Don’t use old payer forms or outdated fax/email contacts
• Don’t ignore re-credentialing timelines or CAQH attestation dates
• Don’t rely on one contact—create a chain of accountability
• Don’t give up if you're denied—appeal with data and community support.

Background:-

Credentialing has become more complex, risk-prone, and technology-driven than ever before. What used to be a manual, administrative process is now a make-or-break gateway for provider reimbursements, payer participation, and even legal compliance. The growing use of AI in payer systems, stricter state and federal oversight, and disappearing provider support have created a perfect storm—one where even small credentialing mistakes can lead to lost revenue or network termination.

Whether you're a provider, credentialing specialist, or office administrator, understanding the right way to manage credentialing—and what to avoid—is critical for the financial health of your practice. This session will help you navigate the most common pitfalls and take control of the credentialing process.

Why Should You Attend?

• You’ve submitted applications and never heard back—or worse, were denied without explanation.
• You want to understand what payers really expect in 2025 and how to meet those standards.
• You’re tired of delays, AI-driven denials, or losing participation without notice.
• You want to train your team to avoid mistakes that cost money and time.
• You’re launching a practice or adding a new provider and need a checklist for success.

Who will Benefit?

• Practice manager
• Credentialing specialist
• Credentialing manager
• Billing manager
• Practice administrator
• Front desk manager.