National Shared Credentialing: Challenges, Costs, and Solutions

The notion of applying a quick fix is something that everyone in health care can relate to. It speaks to problems that are clearly recognized, repeatedly addressed at the surface, but never truly solved.

Provider credentialing is one such problem… and the bleeding has been happening for years.

Payers found that their fax-and-data-entry systems were slow and cumbersome, so they attempted to build internal systems to manage credentialing data, only to find that the fix introduced integration barriers and added administrative burden.

Providers must complete dozens of forms to update information, then wait weeks (or even months) for credentialing data to be processed. To address this, attempts were made to align systems, but misaligned incentives led to siloed data and errors.

And hospital systems tried to manage credentialing through proprietary workflows and systems, only to discover that their point solutions and temporary fixes didn’t solve the problem; they just drove a shifting market focus.

These short-term solutions may have stopped the bleeding for a while, but did nothing to address the overarching issue that provider data management (and credentialing) across the U.S. healthcare system is duplicative, slow, and expensive. For too long, we’ve relied on partial fixes like new workflows layered on top of old ones, proprietary systems that don’t talk to each other, and administrative workarounds that shift the burden rather than remove it.

At CertifyOS, we know it’s time for a change.

The healthcare industry has treated credentialing as an isolated function rather than a shared infrastructure, and the workarounds that followed have only compounded the problem. Recently, we have been contemplating the core challenges of national shared credentialing and considering what a real workable solution could look like. In this article, you’ll find our initial thoughts, and we'll then articulate our “big dreams” for a solution. These “dreams” are still in development, but we are working hard to make them a reality so we can resolve the credentialing problems facing payers, providers, and systems once and for all.

Challenge #1: The Processes for Managing Credentialing Are Fundamentally Broken

Health plans routinely repeat the same credentialing checks that other plans have already completed. A single provider who is in-network with multiple payers must repeatedly submit the same documentation for licenses, education, and work history, while each payer independently verifies the same information.

This redundancy wastes time, money, and human resources across the system. It also introduces unnecessary administrative burden for providers, who are forced to navigate repetitive, manual workflows simply to stay in-network, get paid, and see patients.

The CertifyOS Solution: Tech-Enabled Workflows with Quality Standards

We believe that replacing today’s credentialing approaches requires a shared, scalable asset explicitly designed to support credentialing with rapid turnaround and high accuracy. This infrastructure should be built with defined accuracy, timeliness, and accountability to permanently solve credentialing problems, not just provide a temporary fix.

Challenge #2: Inconsistent Requirements Across Plans

Credentialing requirements vary widely between payers. Timelines don’t align, verification standards differ, and submission formats vary. As providers juggle multiple plans, the administrative burden increases, and so does the likelihood of incomplete or inaccurate information. Even when providers do everything right, misaligned timelines mean records are often technically “out of date” for at least one payer at any given time.

The CertifyOS Solution: Timeline Alignment and Standardized Verifications

A shared provider data management system could update credentials based on the earliest common verification date, ensuring that credentialing data remains valid in all systems, regardless of their individual requirements or timelines. When verification standards are aligned (or at least mapped consistently), every payer gets what they need without forcing providers to resubmit information repeatedly. Standardization doesn’t remove flexibility; it removes chaos.

Challenge #3: Lengthy Delays Impact Care and Revenue

Credentialing delays can stretch from weeks to months. During that time, providers may be unable to treat patients, submit claims, or receive reimbursement, even if they’re ready to practice or have patients waiting for care. These delays don’t just hurt providers; they reduce network adequacy for payers and limit patient access, especially in underserved areas.

The CertifyOS Solution: Streamlined Access Through Shared Infrastructure

To date, no one has cracked credentialing speed because speed requires coordination. A large-scale shared infrastructure would enable real-time updates, faster verifications, and immediate visibility across systems. When credentialing moves from a serial process to a shared one, timelines will shrink, benefiting everyone.

Challenge #4: Rising Administrative Costs

Healthcare administration is expensive. As the administrative burden grows, administrative teams become increasingly burdened, clinicians spend more time on paperwork, and organizations spend more and more on operations. As this happens, stakeholders become reluctant to invest heavily in custom healthtech that appears to be only a temporary fix for the problem. For many, the cost of new technology and systems becomes a barrier to solving even the most burdensome problems.

The CertifyOS Solution: Subscription-Based Economics

CertifyOS knows that massive upfront technology investments can be a deal-breaker, even if they solve a significant problem. That’s why CertifyOS proposes that a shared credentialing infrastructure should operate on a subscription model, where payers pay for access to a continuously improving platform, reducing capital expense while gaining access to valuable infrastructure. This approach lowers barriers to entry and makes modernization financially sustainable.

Challenge #5: Lack of Alignment Across Stakeholders

The most complex challenge in a shared credentialing strategy is alignment. Everyone agrees our credentialing system is broken, but everyone is solving it differently. It’s like they are all trying to address the same issue with different sizes and shapes of bandages. Siloed systems, proprietary workflows, and competing priorities make collaboration difficult, even when incentives overlap.

The CertifyOS Solution: Transform Credentialing Into Shared Infrastructure

A solution to the credentialing problems is to treat credentialing as a shared, scalable asset rather than a competitive differentiator. A solution with transparent quality metrics that align with all standards, interoperable design, and a tech-enabled structure would allow credentialing to evolve from a fragmented cost driver into a system that improves outcomes for providers, payers, and patients alike.

Moving Beyond Temporary Fixes

Attempts to solve credentialing problems haven’t failed because the problems are unsolvable, but because the solutions haven’t been systemic. They’ve been quick fixes that temporarily stopped the bleeding, but none created lasting, system-wide change.

At CertifyOS, we’re rethinking credentialing from the ground up. We’re working to align incentives, modernize infrastructure, and design for interoperability from day one. Addressing these challenges is a top priority for us, and we’re excited to work alongside our partners to move beyond temporary fixes toward durable, scalable solutions that make credentialing faster, more straightforward, and more trustworthy for everyone.