If you’ve ever had to deal with credentialing, you know the story: the same forms, the same paperwork, the same deadlines — over and over again. Every insurer requires their own process. Every state has its own rules. And if you miss a deadline? It can mean delays in getting reimbursed or, worse, providers being unable to see patients.
Every doctor, nurse, and therapist must be verified by every health plan or payer organization they work with, in every state where they practice. It’s a process designed to protect patients, but it’s become a system defined by redundancy.
It’s frustrating.
It’s costly.
And for clinicians who just want to care for people, it’s one more barrier that gets in the way.
That’s why we’ve launched something new: a national credentialing alliance.
Because this burden isn’t just an annoyance — it’s an industry-wide problem. The inefficiencies pile up across organizations and ultimately affect both providers and patients.
Why the medical credentialing process needs to change
The numbers speak for themselves:
- There are about 4 million credentialed providers in the U.S.
- Each one works with an average of 19 different payers.
- That adds up to 25 million credentialing events every single year.
Each verification cycle costs insurers money, providers time, and health systems opportunities.
Errors or missed deadlines slow things down while blocking providers from practicing and delay patient care. Industry-wide, it costs over $1 billion annually in avoidable administrative waste.
Providers feel that burden every day. And so do payers and health systems trying to keep up with the demand.
Why a national credentialing alliance?
With so much overlap in provider networks, credentialing is uniquely positioned to be centralized. Rather than repeating the same process across every payer, the industry could treat credentialing as a single, standardized event.
Local or regional experiments at coordination have helped, but none have scaled nationally.
Medallion’s new initiative, CredAlliance™, is the first national clearinghouse for credentialing.
Built to support consistency, compliance, and speed, without requiring any data-sharing between plans, CredAlliance eliminates duplication across the industry and reduces costs for all payers involved. Plus, providers face fewer delays, and patients get faster access to care.
As Derek Lo, Medallion’s founder and CEO, said to Forbes: “It doesn’t make sense to credential the same doctor 20 times and to do it every three years across all these plans. There should be a single clearinghouse to standardize this.”
What it takes to build an alliance
Creating a true alliance requires more than technology. It takes alignment across insurers, providers, and regulators, as well as a willingness to rethink how back-office operations can drive better patient outcomes.
At its core, CredAlliance lowers costs, improves provider experience, and raises the standard of credentialing across the industry. By sharing costs among members, the alliance reduces payer OpEx, eliminates many third-party pass-through fees, and aligns re-credentialing dates to cut administrative hours while improving provider satisfaction.
Powered by Medallion’s NCQA-certified CVO, CredAlliance delivers three-day SLAs on credentialing turnaround times, automates compliance with NCQA, CMS, and plan-specific rules, and integrates easily through an open API. The result: faster, higher-quality credentialing at lower cost — and a better experience for both providers and patients.
With that, three ingredients of Medallion CredAlliance stand out:
- Scale and trust
A clearinghouse only works if payers trust the process — and if enough of them join. With several dozen payers already signed on, and five of the nation’s largest health plans considering membership, CredAlliance is achieving the scale required to reset the standard.
- Shared incentives
Traditionally, each insurer has shouldered credentialing costs individually. Legacy vendors typically lock plans into fixed-rate models that don’t improve as adoption grows. By contrast, CredAlliance operates on a true cost-sharing model — the more payers that participate, the greater the savings for everyone.
- Technology + policy integration
Automating paperwork is only the first step. Medallion’s platform aligns credentialing expiration dates, reduces administrative overhead, and integrates with existing compliance frameworks. But national adoption also requires ongoing collaboration with regulators and policymakers to ensure the process meets healthcare’s rigorous standards.
Why now?
The U.S. faces a growing shortage of doctors and nurses. Every unnecessary barrier that slows them down compounds the crisis. Streamlining credentialing is not just an operational win — it’s a public health necessity.
Backed by our recent $43 million fundraise led by Acrew Capital, Medallion is doubling down on building the AI infrastructure and operational scale required to power this national alliance. Our goal isn’t to make credentialing a little better. It’s to fundamentally reimagine it.
The road ahead
Building a national credentialing alliance is an ambitious challenge, but one we believe the healthcare system can’t afford to ignore. By tackling one of the industry’s great unsung problems, CredAlliance is setting the foundation for a future where provider access is faster, more reliable, and more cost-effective.
We believe the path to better healthcare doesn’t just run through exam rooms and hospitals — it runs through the invisible systems that enable providers to practice. And with CredAlliance, we’re finally giving credentialing the transformation it deserves.
Join us in shaping the future of medical credentialing. Learn more about CredAlliance and how your organization can participate.
