One of the biggest misconceptions providers have about credentialing is assuming that once they are credentialed with one insurance company, the process should be similar with the next. In reality, credentialing differs significantly across insurance companies, even when the requested information appears identical.
Understanding these differences helps providers set realistic expectations and avoid repeated delays that disrupt cash flow.
There Is No Universal Credentialing Standard
Unlike Medicare, commercial insurance companies do not follow a single credentialing framework. Each payer establishes its own requirements, internal workflows, and approval standards.
This means:
- Different application formats
- Different documentation requirements
- Different review timelines
- Different approval authorities
Two insurers may request the same data, but how they review and validate it can be completely different.
Application and Portal Differences
Some insurance companies rely heavily on CAQH data and require minimal supplemental applications. Others require extensive payer-specific forms in addition to CAQH.
Common variations include:
- Online portals versus manual forms
- Separate applications for individual and group credentialing
- Different formats for ownership disclosures
- Unique attestations and authorizations
Failing to follow a payer’s exact process often results in applications being returned or stalled.
Review Processes Vary Widely
Credentialing review is not always linear.
Some payers:
- Conduct rolling reviews with continuous processing
Others:
- Route applications through credentialing committees
- Review applications only during scheduled cycles
- Require multiple internal approvals
If an application misses a review window, approval may be delayed by weeks without any indication that progress has stopped.
Network Status Changes Everything
Credentialing requirements and timelines are heavily influenced by network status.
If a payer’s network is:
- Open, applications move forward more smoothly
- Limited, applications may face additional scrutiny
- Closed, applications may be delayed indefinitely or declined
Providers are rarely informed of network status upfront, which leads to confusion when applications stall without explanation.
Documentation Standards Are Not Consistent
Insurance companies differ in how strictly they interpret documentation requirements.
Differences may include:
- Malpractice coverage limits
- Acceptable explanations for work history gaps
- Verification of board certification
- Requirements for hospital affiliations
What is acceptable to one payer may trigger follow-up requests from another.
Communication Styles Create Confusion
Some insurance companies provide clear status updates and responsive support. Others offer minimal visibility into application progress.
Providers often experience:
- Long periods without updates
- Requests communicated only through portals
- Delayed responses to follow-ups
- No clear escalation path
This inconsistency makes it difficult to track progress without active management.
Why Providers Struggle With Multi-Payer Credentialing
Credentialing across multiple insurance companies becomes challenging because:
- Each payer requires a tailored approach
- Processes cannot be reused blindly
- Timelines overlap unpredictably
- Errors compound across applications
Treating all payers the same is one of the fastest ways to create delays.
How Cred2RCM Manages Payer-Specific Differences
Cred2RCM approaches credentialing as a payer-specific process.
By working with https://cred2rcm.com/, providers benefit from:
- Customized submissions based on payer requirements
- Proactive follow-up aligned with each payer’s workflow
- Early identification of network-related barriers
- Cleaner approvals with fewer restarts
- Better coordination between credentialing and billing
This tailored approach reduces frustration and speeds time to reimbursement.
Credentialing Requires Flexibility, Not Assumptions
Insurance companies may request similar information, but they do not evaluate it the same way.
Providers who recognize payer differences, adjust their approach, and manage credentialing proactively experience fewer delays and more predictable revenue.
In private payer credentialing, similarity is an illusion.
Strategy is what keeps things moving.