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Credentialing has never been a fast process, but 2026 is raising the stakes. CMS updated its Medicare enrollment application (CMS-855B) in December 2025, adding documentation requirements for group practices and other suppliers (CMS, 2025). Payers continue to tighten re-credentialing timelines. And the administrative burden of managing provider data across dozens of payers is growing, not shrinking.
For most RCM teams, the honest question isn't whether credentialing software is worth the cost. It's how much the lack of it is already costing them.
This article breaks down where those costs actually live, what improvement looks like with specific benchmarks, and how to build a simple ROI case for your leadership team.
The Problem: What Inaction Actually Costs
Manual credentialing is slow by design — or rather, by default. Provider applications move through fax queues, email threads, and payer portals with little visibility into status. When a step gets missed, no one knows until a claim is denied or a provider can't bill.
The CAQH 2025 Index found that the healthcare industry still spends billions annually on avoidable administrative transactions, with provider data management and credentialing identified as key contributors to manual process inefficiency (CAQH, 2025). While payers have made progress in automating eligibility and claims channels, credentialing remains disproportionately paper-dependent.
The downstream costs are real:
- Lost revenue during enrollment gaps. Providers who aren't credentialed can't bill. Days or weeks of unbillable services accumulate while applications sit in payer queues. For a busy specialist, that can represent significant lost collections per week.
- Staff time on status chasing. Without a centralized system, credentialing coordinators spend hours each week calling payers, resending documents, and manually tracking expiration dates.
- Compliance and re-credentialing risk. Missing a re-credentialing deadline can result in a provider being temporarily removed from a payer's network. Catching that after the fact is expensive to fix.
Where Credentialing Costs Actually Come From
Understanding the ROI of credentialing software requires disaggregating the cost into its actual components. Most teams underestimate the total because they only count the obvious line items.
1. Labor Costs for Manual Data Entry and Follow-Up
Each new provider enrollment involves collecting the same information — licenses, DEA numbers, malpractice history, CAQH attestations — and submitting it separately to each payer. That's not a one-time task. CAQH requires quarterly attestations to keep provider profiles current, and missing an attestation cycle can delay authorization or trigger re-verification (CAQH, 2025).
For a billing company managing dozens of providers across multiple payers, this is a full-time workload. Without software to centralize and automate this data, the labor cost compounds quickly.
2. Rework from Rejected or Incomplete Applications
Payer rejections due to incomplete documentation or outdated information require staff to restart portions of the process. The CMS-855B alone is a multi-section form requiring precise documentation of group practice structure, ownership, and billing relationships (CMS, 2025). One missing field means re-submission, re-review, and additional delay.
3. Credentialing Backlogs and Provider Onboarding Delays
When credentialing is manual and coordinator-dependent, volume spikes create bottlenecks. New provider hires or acquired practices stall because there's no scalable workflow. Revenue doesn't start flowing until enrollment is complete.
4. Audit and Compliance Exposure
Payers and accreditation bodies expect documented, auditable credentialing processes. Manual spreadsheet tracking is difficult to audit and easy to challenge. Errors or gaps can affect payer contracts and Joint Commission status.
What Improvement Looks Like: Specific Benchmarks
Credentialing software addresses each cost category above through workflow automation, centralized data management, and payer-specific tracking.
Across the RCM technology landscape, Becker's Hospital Review has identified provider data management and credentialing automation as among the highest-ROI investment areas for health systems and billing companies in 2025 (Becker's Hospital Review, 2025).
Organizations that integrate credentialing software with their broader RCM stack — including tools that automate payer outreach for enrollment status and follow-up — see additional gains. SuperDial customers using automated payer communication workflows, for example, have documented up to 4x team throughput without adding headcount, which directly benefits credentialing teams managing high provider volumes.
Specific improvements to look for:
- Reduction in average enrollment time from application submission to payer approval
- Decrease in rejected applications due to incomplete or outdated data
- Staff hours reclaimed from manual status chasing
- Reduction in provider "billing gap" days between hire date and first clean claim
A Simple ROI Framework for Credentialing Software
Use this structure to build a business case:
Step 1: Calculate your current credentialing labor cost
Count the number of staff hours per month spent on credentialing tasks (new enrollment, re-credentialing, status follow-up, data updates). Multiply by fully loaded hourly cost.
Step 2: Estimate revenue leakage from enrollment delays
For each provider, identify the average billing gap between hire and first approved claim. Multiply by average weekly collections to estimate lost revenue per provider, per month.
Step 3: Add rework and compliance costs
Estimate monthly staff time spent on rejected applications and re-submissions. Add any costs from missed deadlines (payer re-credentialing lapses, compliance reviews).
Step 4: Project the savings
Compare current total cost against your software vendor's documented outcomes. Ask vendors for case-specific data: time to completion, rejection rates, staff hours per enrollment.
Step 5: Account for scale
If your provider roster is growing, the ROI case strengthens with volume. Manual processes don't scale; software does.
Bottom Line
Credentialing software isn't a nice-to-have in 2026. Between CMS enrollment updates, payer data requirements, and CAQH attestation cycles, the administrative complexity of provider credentialing is increasing. The cost of managing it manually — in staff hours, enrollment delays, and compliance risk — is measurable and, in most cases, larger than teams realize.
The ROI framework above gives you the structure to quantify it. The next step is running the numbers for your own organization.
Sources
- CAQH. (2025). CAQH Index 2025. DataSpring, powered by CAQH. https://www.caqh.org
- CMS. (2025). Medicare Enrollment Application for Clinics/Group Practices and Other Suppliers (CMS-855B, 12/2025). Centers for Medicare & Medicaid Services. https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855b.pdf
- Becker's Hospital Review. (2025). 388+ Revenue Cycle Management Companies to Know: 2025. https://www.beckershospitalreview.com/lists/388-revenue-cycle-management-companies-to-know-2025
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