The Dos and Donts of Provider Credentialing + 2025 Provider Credentialing Guide

The Dos and Don'ts of Provider Credentialing with Insurance Payers: Avoiding Denials, Delays and Lost Revenue + 2025 Provider Credentialing Guide: Avoiding AI-Driven Denials and Enrollment

2025 Provider Credentialing Guide: Avoiding AI-Driven Denials and Enrollment

In 2025, provider credentialing is no longer a background administrative task—it’s a frontline battleground affecting payments, compliance, and the very survival of healthcare organizations.

With insurance companies streamlining their internal teams, removing traditional provider support lines, and outsourcing credentialing departments to third-party vendors, the process of becoming—or remaining—a participating provider has become increasingly unpredictable. Payers are taking longer to respond, often extending timelines far beyond what is published, and issuing blanket denials without clear reasoning or appeal instructions. At the same time, practices are expected to continue rendering services while facing increasing risks of non-payment, audit exposure, and even contract termination.

Compounding the issue is the rapid adoption of Artificial Intelligence (AI) by major insurance companies. AI is now being used not only to audit provider charts and claims but also to proactively assess “risk scores” that can trigger silent credentialing denials, delays, or even removals from networks. These AI-driven decisions often happen without notice, without peer review, and without any opportunity for correction or escalation. For providers and credentialing professionals, this shift marks a dangerous turning point, where being accurate and compliant is not enough if you're also not aware of what data insurers are tracking.

This webinar will examine the latest trends and challenges in provider credentialing and enrollment, including:

• Extended credentialing timelines and how to plan for delays that go well beyond 90–120 days
• Unreachable payer support teams: What to do when no one answers the phone or replies to follow-ups
• Contract denials without justification and how to build defensible appeal records
• The role of peer review in modern credentialing and how insurers use it to delay onboarding or flag providers
• Billing risk when credentialing is delayed but claims are submitted: What is safe vs. what creates legal exposure
• A growing disconnect between provider submission and payer processing systems, especially when third-party vendors are involved
• Medicare enrollment bottlenecks, revalidation challenges, and the consequences of missed deadlines
• How AI is now controlling network participation, reimbursement policies, and audit targeting—and what providers can do about it

We will also explore solutions and proactive strategies, including:

• Tools and methods to track and document credentialing efforts
• How to escalate credentialing issues when payer communication channels have collapsed
• Building internal workflows that combine billing, credentialing, and compliance visibility
• Using data and reporting to protect against AI profiling and algorithm-driven exclusions
• Ways to monetize credentialing services if you're a billing company or MSO seeking to grow revenue and deliver more value to providers

This session is designed for:

• Credentialing managers and specialists
• Medical billing and RCM professionals
• Practice administrators
• Compliance officers
• Healthcare consultants and MSOs
• Independent providers seeking to better understand the credentialing landscape

Whether you’re trying to get new providers enrolled, respond to a puzzling denial, or simply make sense of why applications are stuck in limbo, this webinar will give you the insights, tools, and real-world examples you need to stay ahead in an increasingly complex, AI-driven credentialing environment.

Learning Objectives

• Identify current trends and policy changes impacting provider credentialing, including Medicare enrollment delays, payer denials, and extended application timelines.
• Recognize the risks associated with credentialing delays, including billing disruptions, non-payment, audit exposure, and provider compliance violations.
• Understand how insurance companies are using AI to automate audits, assess provider risk, and make credentialing decisions without direct communication.
• Implement strategies to manage credentialing barriers, such as unreachable payers, missing escalation channels, and outsourced customer service models.
• Use documentation and tracking tools to monitor credentialing progress, support appeals, and defend against denials or payer inaction.
• Develop workflows that align billing, credentialing, and compliance teams to minimize payment risks and improve internal efficiency.
• Apply best practices to monetize credentialing services and scale them as a revenue-generating function within a billing or MSO business.
• Prepare for the future of credentialing oversight, including peer review triggers, audit trends, and payer AI profiling that may impact network participation.

Areas Covered

• Enrollment & Credentialing Delays
• Contract Denials & Communication Breakdowns
• Billing & Reimbursement Risks
• Provider Compliance & Peer Review Challenges
• AI-Driven Credentialing Controls
• Proactive Strategies & Tools.

Background

Credentialing and enrollment are no longer routine back-office tasks — in 2025, they’re the frontline of provider survival.

In this fast-paced and urgent session, we explore the most pressing challenges affecting provider enrollment and credentialing today. From Medicare’s shifting requirements and application timelines that stretch months past expected deadlines, to payer denials with no clear reasoning, the enrollment process is becoming a serious threat to provider revenue and network participation.

We'll also examine how insurance companies are increasingly using AI to flag, delay, and even terminate providers — all without ever speaking to a human. With many payers eliminating or outsourcing customer service functions, your ability to escalate, appeal, or even get updates is disappearing.

This webinar will equip you with:

• The latest trends and policy shifts impacting provider credentialing in 2025
• How enrollment delays are tied to claim denials and payment disruptions
• Strategies to manage peer review requests, credentialing audits, and contract rejections
• Real-world examples of payer behavior shaped by AI algorithms
• What providers, billing teams, and compliance officers must do now to protect network participation
• Proactive tools for tracking applications, handling escalations, and documenting payer inaction

Whether you’re a credentialing specialist, billing manager, or healthcare executive, this webinar will help you stay ahead of the chaos.

Why Should You Attend

• A clear understanding of how enrollment issues directly impact reimbursement and audits
• Tools to track applications and escalate unresolved cases
• Strategies for dealing with peer reviews, pre-payment flags, and silent denials
• Insight into how AI is reshaping credentialing risk — and what data insurers are watching
• Actionable steps to protect your practice’s participation and cash flow

Who Should Attend

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

The Dos and Don’ts of Provider Credentialing with Insurance Payers: Avoiding Denials, Delays & 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.