The Hidden Crisis in Healthcare: 5 Warning Signs Your Credentialing System Is About to Break Down

As the founder and CEO of Assured, I've helped transform thousands of credentialing processes so doctors can work faster and more safely. One truth is clear: credentialing is the critical gatekeeper for healthcare quality and safety—when it fails, providers get sidelined and patient care suffers.

If you’re running a healthcare organization, keep an eye out for these warning signs. They may be indicative of issues on the horizon: 

1. Your Operations Are Raising Red Flags 🚩

Operations aren’t just about your current state. They’re also about your trends. If your team is showing these signs – even if operations are currently unproblematic – they’re often warnings: 

• Growing backlog of credentialing files 

• Increasing turnaround times for processing applications

• High error rates between documentation and primary sources

• Missing information in provider files

• Spike in expired credentials (licenses, certifications, liability insurance)

These aren't just minor inconveniences—they're early indicators of system failure. When I speak with healthcare executives, many don't realize these warning signs until they're facing a full-blown crisis.

2. Your People Are Telling You Something's Wrong 🗣️

Your people are your largest asset. When they provide warnings, it’s often easy to dismiss them as individual taste or a single perspective. But I’ve seen these valuable bellwethers go ignored for too long – until sometimes it’s too late: 

• Staff burnout and high turnover in your credentialing team

• Provider complaints about delays growing louder

• Clinical departments unable to staff because providers are stuck in credentialing

• Teams working overtime but still falling behind

Remember: your credentialing team and providers will often sense problems before metrics capture them. Listen to these voices.

3. You're Only Looking Inward, Not Outward 🔍

While your internal team is the best measure of your internal health, it can be hard to judge your overall performance without an external benchmark. Successful performance tracking requires both internal benchmarks and industry comparison. 

For example, internal benchmarking can allow you to track your metrics over time to identify concerning trends, and know when changes represent normal fluctuation versus warning signs. 

These two elements don’t guarantee you’re doing well in the larger industry. Thankfully, you can also use these industry comparisons: 

• NCQA standards (which provide objective benchmarks for everyone)

• Industry conferences (which offer opportunities to learn from peers) 

• Understanding what's considered healthy in the broader industry

Many organizations I work with excel at one but neglect the other. Both views are essential for a complete picture of your credentialing health.

4. You're Settling for Industry Standards Instead of Innovation 💡

True excellence requires moving beyond established practices. In an ever-changing competitive landscape, successful teams will: 

• Question the status quo: "What could this be if we leveraged new technologies?"

• Design from scratch rather than building on existing systems

• Optimize based on your specific organizational circumstances

• Leverage AI and other technologies to transform processes

Industry metrics are useful for understanding trends but shouldn't constrain innovation. At Assured, we've seen organizations reduce credentialing time by upwards of 70% when they break from conventional approaches.

5. You're Not Prepared for External Disruptions 🌪️

Your personal performance is only one element of a much larger system. While building your organization, you still must keep an eye out for factors beyond your control that can severely impact credentialing, including: 

• Regulatory changes and leadership transitions at CMS

• Policy changes affecting credentialing requirements

• Primary verification sources experiencing outages or downtime

Through all these elements, your resilience will be key. The best ways to build it are through: 

• Monitoring policy developments proactively

• Developing multiple contingency plans

• Maintaining alternative verification pathways

• Creating transparent communication protocols for disruptions

When a major event hits – and it will – the best-prepared teams will adapt their credentialing within days while others struggle for months.

The Path Forward

Excellence in credentialing requires both preventing breakdowns and pioneering innovations. Organizations that master this balance protect quality of care while enabling providers to focus on their primary mission: caring for patients.

At Assured, we're committed to transforming healthcare credentialing from a potential point of failure into a strategic advantage. If these elements were helpful for you, I’d love to hear how we can be more helpful in your process.