5 trends shaping payer enrollment and medical credentialing in 2026
Provider enrollment and credentialing are often seen as administrative tasks. In reality, they directly impact patient access, billing timelines, and team bandwidth.
Findings from Medallion’s 2026 State of Payer Enrollment and Medical Credentialing survey show hospitals, provider groups, and health plans trying to move faster with fewer people, more systems, and tighter compliance expectations.
Here are five takeaways that point to where healthcare organizations’ pain is mounting and where forward-looking teams are focusing their attention next.
1. How do credentialing delays impact hospital revenue?
Credentialing delays now create real, measurable revenue loss.
Among hospitals able to quantify the impact, 1 in 5 report losing more than $1M annually due to delayed provider activation. When providers can’t start seeing patients, revenue is delayed and capacity goes unused. For organizations that can’t measure the impact, the risk often goes unnoticed, but it still affects the bottom line.
2. What is the most unpredictable stage of provider credentialing?
Committee review is the most unpredictable and delay-prone stage of the credentialing process.
Nearly 30% of provider groups wait more than 8 days for committee approval, and 17% wait more than 31 days. Even when earlier steps are efficient, delays at this stage make provider onboarding timelines difficult to trust. That uncertainty complicates scheduling, staffing, and growth planning.
3. Why do fragmented credentialing systems slow provider onboarding?
Fragmented systems slow work by increasing handoffs and manual coordination.
43% of provider groups use two systems to credential a provider, while 32% rely on three or more. Each added tool makes it harder to track progress and understand where work stalls. Over time, this complexity limits visibility and makes processes harder to scale.
4. Why is visibility across credentialing workflows still limited?
Many organizations lack a clear view of where providers are in the credentialing process.
Only 57% of provider groups report full visibility into privileging, and 62% say they understand how files move through committee review. Without that visibility, teams spend more time chasing updates than managing performance. Leaders are left reacting to delays instead of preventing them.
5. What’s slowing automation and AI adoption in provider credentialing for payers?
Automation adoption is constrained by readiness gaps, not lack of interest.
21% of health plans are investing in AI for provider credentialing and directory management, but legacy system integration (20%) and limited internal AI expertise (18%) remain the biggest barriers. Payers see automation as a way to reduce manual work, speed time-to-network, and improve provider experience. Many just need solutions that are easier to implement and maintain.
Thoughts on what high-performing teams are doing differently
Across hospitals, provider groups, and health plans, the same pattern emerges. Credentialing and enrollment teams are being asked to move faster while managing more complexity and fewer resources. Organizations that simplify workflows, improve visibility, and support constrained teams are better positioned to reduce friction and sustain performance over time. To explore the full findings and see how hospitals, provider groups, and health plans are responding, download the 2026 State of Payer Enrollment and Medical Credentialing report and see how your organization compares.
FAQ
What is the biggest challenge in provider credentialing today?
The biggest challenges are unpredictable timelines, staffing constraints, and limited visibility — especially during committee review.
How do credentialing delays affect healthcare organizations?
Delays can lead to lost revenue, slower patient access, administrative burnout, and increased compliance risk.
Why is automation important for credentialing teams?
Automation helps teams reduce manual work, improve consistency, and onboard providers faster without increasing staff burden.
What prevents organizations from adopting credentialing automation?
The most common barriers are legacy system integration challenges and limited internal expertise — not lack of interest.
What are the biggest trends in payer enrollment and credentialing in 2026?
Credentialing delays are causing measurable revenue loss, committee review remains the most unpredictable step, fragmented systems slow onboarding, visibility is still limited, and automation adoption is constrained by legacy technology and expertise gaps.
How do credentialing delays impact hospital revenue?
Hospitals report losing over $1 million annually when providers cannot see patients due to delayed credentialing and activation.
Why is committee review a bottleneck in credentialing?
Committee review introduces unpredictable delays, with nearly 30% of provider groups waiting more than eight days and 17% waiting over a month for approval.
