Payer timelines,
state by state

What 64K+ enrollment records reveal and how it should shape your 2026 planning.

Medallion’s 2025 Geography of Payer Enrollments Report shows how approval timelines vary by state — and what it means for providers, payers, and patients.

The data is in...

In our analysis of more than 64,500 enrollment submissions across all 51 states and territories, we found major differences in how long it takes to get a provider billable.

Timelines vary dramatically by market. On the low end, the weighted median in Hawaii is 32 days; on the high end, Delaware’s 90th percentile reaches 196 days. Here's a quick look at four key takeaways:

60 days

National weighted median turnaround time

75 days

to get enrolled for 1 in 4 states

100+ days

to get enrolled for the slowest states

196 days

to get billable in Delaware

The national picture: The median provider enrollment turnaround times

Enrollment timelines shown are rounded from source data for easier comparison.

Select a State

But the median doesn’t tell the whole story.

At the higher end of the curve, some providers are waiting nearly six months. In states like Delaware (196 days at the 90th percentile) and Michigan (175 days), outliers push timelines far beyond the median.

Even in states with stronger averages, like Massachusetts, the 90th percentile shows providers can still wait over 160 days to be billable.

These extremes highlight that enrollment delays aren’t just statistical blips.

For providers stuck at the long tail of the process, payer approvals can delay when they can start seeing reimbursable patients — and for health systems, that’s months of capacity locked out of circulation.

Where delays run deepest

Some of the longest waits are in Vermont, Michigan, New Mexico, North Dakota, and South Dakota, where the weighted median stretches to 3+ months.

What might be contributing to longer enrollment timelines in certain states? We’re seeing a few potential factors that could explain the delays.

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Many of these states lack centralized payer systems.

Providers must often work through fragmented regional or multi-plan networks.

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That means multiple, parallel enrollment processes that pile on time and effort.

As a result, providers in these states are sidelined, unable to see patients, while revenue stalls for both clinicians and systems.

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Delays hit hardest in rural-heavy states.

Delays are felt the most in rural-heavy states. North Dakota, South Dakota, Vermont, and Montana all report weighted median enrollment times exceeding 85–90 days. These states already face access challenges — long distances, fewer providers, and underserved populations. Long enrollment timelines only add another barrier for patients who can least afford it.

Enrollment lag also overlaps with Health Professional Shortage Areas (HPSAs).

A Health Professional Shortage Area (HPSA) is a federal designation issued by the Health Resources and Services Administration (HRSA). HPSAs identify communities where access to health services is limited due to an insufficient number of providers relative to the population’s needs.‍

430

HSPA designations in Virginia

557

HSPA designations in New York

766

HSPA designations in Michigan

Not all high-volume states are slow.

Maine proves the opposite.

Delays aren't inevitable
With the right infrastructure, states can move quickly even under heavy administrative load.
7,177 enrollments
We looked at the highest volume of processed enrollments in the nation.
Maine
And we found that despite the administrative load, Maine delivered the second-shortest turnaround time in the country.

Total completed enrollments vs weighted average median of STC

Where enrollment moves fastest — and why it matters for growth

Just as some states lag, others set the pace. Several states combine speed with efficiency, showing it’s possible to process enrollments in under 40–50 days — nearly half the time of the slowest markets.
Hawaii and Maine report median turnaround times around 32–40 days, the fastest in the nation.

Georgia and Indiana also stand out, pairing high volumes with short timelines. Georgia alone processed over 2,500 enrollments with a median of just 45 days.

For health systems and provider groups, these fast states can become strategic launchpads for growth.

Shorter enrollment timelines mean:

See patients sooner
New clinicians can begin billing and seeing patients sooner.
Decrease in delays
Systems can ramp up new sites or service lines more quickly.
Risk reduction
Financial risk tied to delayed reimbursement is significantly reduced.
For payers, it means stronger network adequacy and the ability to bring members access to new providers more quickly.

As organizations evaluate where to expand, it’s critical to weigh not just workforce availability and patient demand, but also the administrative speed of the market. Scaling in states with shorter enrollment timelines can translate into millions in accelerated revenue and faster access to care.

Enrollment delays don’t affect every state equally. Scale changes the stakes.

When large states experience enrollment delays, the consequences scale with the size of their insured populations.

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Delay impacts access

In South Dakota (~750K insured), a 90-day delay impacts access — but within a contained population.

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Delay drains revenue

In Michigan, New York, or Texas, the same delay multiplies into millions of delayed patient visits and hundreds of millions in deferred revenue.

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Delayed enrollment limits access for every patient who relies on that provider for care. In large states, the ripple effect reaches millions of patients and billions in healthcare dollars. Faster enrollment speeds up both access and growth.

Median submission to completion payer enrollment timelines vs estimated state population size

What this all means for providers, payers, and health systems

For providers

Delays mean months of work without reimbursement.

For payers

Delays mean underutilized networks and frustrated members.

For health systems

Delays mean clinicians hired to fill shortages can’t actually see patients.

The takeaway: enrollment timelines are not just red tape — they’re a critical driver of access, revenue, and growth.

Why you need a partner to move faster

State-level bottlenecks and payer differences will never fully go away. While enrollment delays are not inevitable, the right partner can help you shorten the timelines that you can control, all the while working with payers to advocate and quicken the submission process.
A partner with the infrastructure, scale, and industry know-how can help you move from waiting months for approvals to getting providers in-network, billable, and seeing patients much sooner.

Medallion’s scale, infrastructure, and payer expertise helps eliminate resubmissions, streamline submissions, and proactively advocate with payers. That’s the difference between waiting months for approvals versus getting providers in-network, billable, and seeing patients much sooner.

With Medallion,

health systems and provider groups benefit from:

Faster submissions

Automated workflows that gather provider data up front and push clean applications out the door without manual delays.

Roster-based submissions

Bulk processing to streamline large groups of providers into payer networks at once, rather than one-off applications.

AI-driven automation

Intelligent checks and validation rules that help prevent resubmissions and costly denial loops.

Direct integrations

Including CAQH, Nursys, NPDB, and more , to pre-populate data and reduce redundant provider outreach.

Economies of scale

Expert oversight from a partner who understands regional and national payer nuances across thousands of enrollments.

Cut enrollment delays.

Scale smarter.

Get in touch

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Methodology

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This report is based on a 12-month lookback period, analyzing enrollment data from August 11, 2024 through August 12, 2025.

To ensure accuracy and relevance, the dataset analyzed excludes the following:

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  • Enrollments that were canceled or paused at the request of the provider organization.
  • Enrollments with multiple dependencies tied to concurrent applications with other groups or Medicare/Medicaid, which could not be individually isolated for timing analysis.
  • Enrollments that fell outside the scope of Medallion’s contractual agreement with the healthcare organization

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For each state, we aggregated submission-to-completion (STC) data from individual payers and calculated a weighted median turnaround time (TAT), with weights applied according to the number of completed enrollments. This ensures that states with larger volumes of data contribute proportionally more to the overall results.

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Lines of business (LOBs): The analysis spans multiple payer segments, including Commercial, ACA/Marketplace, Medicare Advantage, and Medicaid. Because enrollment timelines vary significantly across these segments, state-level results reflect a blend of payer mix as well as geography. For example, states with higher concentrations of Medicaid managed care organizations tend to exhibit longer enrollment times, while commercial-dominant markets often process enrollments more quickly.

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This approach provides a representative view of enrollment performance across the country while also acknowledging the influence of payer mix within each state.