Credentialing Process Efficiency

Provider credentialing might be the most expensive healthcare problem you’ve never heard of. Traditional credentialing and payer enrollment takes 60-120 days while patients wait months for access to care and healthcare orgs lose $$$ in revenue. Varun Krishnamurthy and Rahul Shivkumar are second-time co-founders who lived this nightmare while building a virtual sleep clinic and scaling to hundreds of providers across 15 states. They ended up building their own in-house tool because nothing else worked. They started Assured to solve this problem for other healthcare companies and now they can credential a provider in just 2 days, with automated workflows instead of manual processes. The market response has been extraordinary: 30% MoM growth, almost 100 customers from Houston Methodist to fast-growing digital health startups, and strong customer love from teams who've suffered through the alternatives. Proud to lead their $6M seed for First Round Capital.

Credentialing still runs on clipboards and copy-paste, and while it may not be killing patients, it’s bleeding healthcare dry. CAQH’s latest Index shows a $20B savings opportunity from reducing administrative waste. Administrative costs eat 15–25% of total U.S. health spending. Most of the facts we need already live in primary sources. State boards. Certification bodies. DEA and exclusions lists. Yet we still ask clinicians to be couriers, re-typing data they don’t control. That is where errors start and timelines slip. This isn’t a staffing problem. It’s an architecture problem. Legacy workflows were built for paper. The fix is clear. Pull verified data directly from the source. Do it once. Reuse it everywhere. You cut rework. You shorten TAT. You generate audit-ready artifacts on demand. NAMSS’ Ideal Credentialing Standards point the same way: standardized elements verified from primary sources. That’s what we’re building at Baton Health. Shared rails for primary-source data delivered by API or Secure Share so hospitals, payers, and CVOs can run credentialing in near real time. If you own credentialing or provider data, let’s talk. I’m happy to compare notes and show what a modern infrastructure looks like. #Credentialing #PrimarySourceVerification #ProviderData #HealthcareOperations #AdministrativeWaste #MedicalStaffServices #NAMSS

AI in Credentialing & Provider Enrollment isn’t about using ChatGPT to write emails. That’s entry-level. The real impact comes from using AI across the workflow—where the administrative burden, delays, and revenue leakage actually live. Here’s what meaningful AI adoption looks like in credentialing, enrollment, and contracting: ✔️ Document intelligence AI validating licenses, board certs, insurance, NPIs, and expirables in real time—reducing manual review and missed gaps. ✔️ Workflow orchestration AI-driven task prioritization based on payer rules, state requirements, and revenue impact—not “first in, first out.” ✔️ Exception detection Surfacing anomalies before payers do: mismatched ownership, taxonomy errors, address conflicts, stale attestations. ✔️ Contract intelligence Extracting fee schedules, escalation clauses, filing limits, and reimbursement terms—so teams stop hunting PDFs and start acting. ✔️ Predictive risk & delays Flagging applications likely to stall due to payer behavior, incomplete data, or regulatory timing—before weeks are lost. ✔️ Operational visibility Dashboards that actually show where revenue is stuck and why—not just task counts. This isn’t about replacing credentialing or enrollment professionals. It’s about freeing them from administrative drag so their expertise is used where it matters most: accuracy, strategy, escalation, and partnership.

As digital health founders, navigating payer credentialing processes can feel overwhelming, but it’s a critical milestone for scaling your company and ensuring smooth patient reimbursements. Here’s a streamlined strategy for negotiating in-network credentials with multiple commercial payers in a short amount of time: 1. Start with the Big Players First Prioritize the largest commercial payers in your region (e.g., UnitedHealthcare, Blue Cross Blue Shield, Aetna, and Cigna). These payers often cover a significant portion of the market, and getting credentialed with them early will help you establish legitimacy with smaller plans. Pro Tip: Use an industry contact or network introduction to bypass gatekeepers and expedite initial conversations with decision-makers. 2. Create a Standardized Credentialing Packet Develop a comprehensive packet with all necessary documents (e.g., licenses, certifications, malpractice insurance, corporate documentation). Having these materials ready in advance will save time when negotiating with multiple payers. Ensure your documentation aligns with the credentialing requirements of the Council for Affordable Quality Healthcare (CAQH), which many payers use. Pro Tip: Automate data entry across multiple portals using a credentialing management tool to save time. 3. Leverage a Delegated Credentialing Agreement For scaling providers, request delegated credentialing during negotiations. This allows your organization to take on the credentialing responsibility, which can significantly accelerate timelines. Payers are more likely to approve this if you already have a track record of quality control and compliance. 4. Negotiate Reciprocity for Smaller Payers Once you secure agreements with the larger payers, use them as leverage with smaller, regional, or specialty plans. Mention your existing in-network agreements to fast-track negotiations by building trust and demonstrating your organization’s credibility. 5. Consider Hiring a Credentialing Specialist or Vendor If you’re scaling quickly, hiring a credentialing service or specialist can accelerate the process, as they already have established relationships with payers and understand the intricacies of the negotiation process. 7. Stay on Top of Compliance and Renewals Credentialing doesn’t end after the initial approval. Set up automatic reminders for document renewals and compliance updates to ensure your providers remain in-network without disruptions. By implementing these strategies, you can fast-track your in-network negotiations and expand your payer coverage faster, helping you reach more patients and drive sustainable growth.

This is what removing barriers to achieve American Maritime Dominance looks like in practice. In a win for maritime professionals, the U.S. Coast Guard has extended the sea service recency period from three to seven years. This common-sense reform is a direct result of industry advocacy and a push for regulations that are backed by data, not legacy rules. The Office of Merchant Mariner Credentialing should be applauded for working to remove flawed regulations that lack clear justification. The Coast Guard has just demonstrated it has the power to issue a policy letter quickly. We are hopeful this will be followed by permanent updates to the CFRs, aligning the rules with the needs of the industry and the intent of Congress. Because you asked, here’s my quick list of simple common-sense reforms that will permanently speed up credentialing, increase access to the industry, and reduce costs for mariners, employers, and the government: 1. CAC for TWIC - Eliminate the redundant and costly TWIC background check for federal personnel, immediately accelerating the military-to-mariner pipeline. 2. We all hold CPR/FA for work - Eliminate the wasteful and brand specific First Aid/CPR prerequisite that causes major delays in credential processing to streamline the application process and reduce administrative burdens. 3. Automatic continuity upon expiration - A mariner’s earned qualifications shouldn't vanish because of a made up deadline that can be fixed in minutes inside of the USCG current software. 4. One fee every time - Replace the complex and error-prone fee structure with a single, flat fee, providing absolute cost predictability for mariners and saving government resources. 5. Skills Don't Expire - Eliminate the arbitrary 'recency' requirement that penalizes valid experience, creating a more equitable system that prevents the loss of skilled personnel. 6. One Sea Service Form - Mandate a single, standard form for civilian sea service to eliminate frequent application errors and ensure consistent, fast and fair evaluations for all mariners. 7. One TOSS for servicemembers - Mandate a single, standardized Transcript of Sea Service (TOSS) form to eliminate the administrative burden on our veterans, making the process faster and more reliable. Check out the Workboat article in the comments about the new policy update. #USCG #Workboat #MerchantMariner #Maritime #MaritimeIndustry 

Provider credentialing is one of healthcare’s most overlooked bottlenecks—slow, manual, and costly. It often takes 90 to 120 days to credential a single provider, costing organizations thousands in lost revenue each month. Assured, a startup that just raised $6 million in seed funding, is tackling this problem with an AI-powered platform for credentialing, licensing, and payer enrollment. The company says it can fully credential a provider in just two business days, compared to months with traditional methods. By verifying credentials across more than 2,000 primary sources in parallel, Assured dramatically cuts time and errors. In just a year, the startup has processed tens of thousands of enrollments, saving customers hundreds of hours every month. The company already works with more than 100 customers, from major health systems to fast-growing digital health startups. Assured is doubling down on R&D to build fully autonomous workflows that scale seamlessly across states and payers. The impact is clear: providers onboard faster, patients get seen sooner, and organizations unlock revenue more quickly. Assured’s vision is simple—take decades of paperwork and turn it into a few days of automation. ~~~ 💡 Enjoy this post? ♻️ Follow Andrew Kuzemczak and subscribe to my healthtech newsletter Future Human for more content like it!

What if every Education, Internship or Job experience came pre-verified? One of the biggest hidden inefficiencies in hiring today isn’t just sourcing or interviewing, it’s trust. Every HR team and staffing firm spends countless hours verifying what candidates claim to have done: Did they actually work there? Did they really use React.js, or just take a weekend course? Were they contributors, or observers? The irony is, we’ve digitized hiring, but not credibility. Profiles look great, portfolios are polished, yet validation still depends on a few phone calls or PDFs from past employers. Now imagine a world where every work experience comes with: - Employer-verified proof of contribution - Skill badges tied to real projects - Validated timelines, who did what, when, and where No inflated resumes. No chasing references. No uncertainty. This kind of credentialing doesn’t just make hiring faster, it makes it fairer for the people who actually did the work. Because when truth is verifiable, talent finally speaks louder than claims. This simple mechanism solves one of the biggest hiring challenges: 🔹 Reduces due diligence time 🔹 Cuts background verification costs 🔹 Builds trust between employers and candidates instantly The question isn’t if this becomes standard, it’s when. What do you think should “verified experience” replace traditional BGV? I’d love to hear from recruiters, founders, and HR leaders on how you see this shaping the next era of hiring trust.

In Provider Enrollment, variability is the enemy of scale. As healthcare organizations expand across states, product lines, and payer types, inconsistent enrollment practices create delays, denials, compliance risk, and revenue leakage. Standardization is no longer just an operational improvement — it’s a strategic advantage. Here’s why standardization in Provider Enrollment matters: 🔹 1. Faster Time to Revenue When workflows, documentation requirements, and submission protocols are standardized, enrollment cycles shrink. Clear intake requirements, checklist-driven submissions, and defined escalation paths reduce rework and eliminate avoidable payer back-and-forth. 🔹 2. Reduced Compliance Risk Standardized policies aligned with CMS, state regulations, and payer delegation requirements ensure consistent adherence. This is especially critical in value-based models, where documentation and oversight are under greater scrutiny. 🔹 3. Improved Data Integrity Clean provider data is foundational. Standard naming conventions, credential verification protocols, CAQH processes, and roster management reduce discrepancies that can trigger claim denials or directory inaccuracies. 🔹 4. Scalable Growth Opening new markets or onboarding large provider groups becomes repeatable and predictable. A standardized enrollment playbook allows organizations to scale without reinventing the wheel in each cohort or grouping. 🔹 5. Stronger Cross-Functional Alignment Enrollment touches contracting, credentialing, revenue cycle, compliance, and operations. Standardized reporting and SLAs improve transparency and support better executive decision-making. 🔹 6. Better Delegation Outcomes For organizations operating under delegated credentialing or enrollment agreements, consistency is critical to passing audits and maintaining delegated status. Standardization does not mean rigidity. It means building a clear framework that allows for payer nuances while maintaining operational discipline. Organizations that treat Provider Enrollment and Credentialing as strategic infrastructure functions — not just administrative tasks— will outperform in speed, compliance, and financial performance. What has been your biggest challenge in standardizing enrollment processes?