Every growth-stage provider organization hits the same wall: you can’t scale revenue if your providers aren’t billable.

Yet across fast-growing health systems, provider groups, and digital health organizations, one process continues to block revenue before it starts: payer enrollment. Delays in enrollment don’t just slow down individual providers. They stall site launches, drag down time-to-revenue, and eat up Ops team capacity — creating organizational drag that compounds as you scale. 

And without visibility into where delays are happening, or why, leaders are flying blind. After years of anecdotal observations about payer turnaround times, we now have data that measures the issue — and highlights meaningful variation in the enrollment experience across the country.

A recent Medallion analysis of more than 64,000 enrollment submissions viewed across all 51 states and territories show clear patterns in turnaround times from submission to completion (STC), provider and organizational revenue impact and geographic disparities in access to care.

The financial cost of enrollment delays

Recent regulatory shifts have made payer enrollment more fragile than ever. For example, the CMS’ new rule shortens ACA sign-up windows and tightens verification requirements — changes that threaten to disrupt coverage and add strain to already burdened teams.

In this climate, each additional verification step or missing field compounds delay, rippling through payers, health systems, and provider groups alike. Enrollment turnaround time has become one of the clearest indicators of operational health — and of financial stability.

Medallion’s national analysis shows the median payer enrollment turnaround time is roughly 60 days from submission to completion, but that figure varies widely by state. In the slowest regions, such as South Dakota, North Dakota, and New Mexico, delays exceed 90 days — translating to $180,000–$220,000 in deferred revenue per provider. Rural-heavy states like Vermont and Montana face similar issues, largely due to fragmented payer infrastructure and non-standardized forms and timelines.

Even in larger states like New York and Texas, where median delays hover around 70 days, the effect is amplified by population scale: a one- or two-week delay can impact millions of covered lives. Today, one in four states operate above the 75-day threshold — clear evidence that administrative lag has become a systemic issue.

Maine, however, defies this trend. Despite managing the highest enrollment volume nationwide — over 7,000 requests — it maintains one of the fastest turnaround times. The takeaway: efficiency isn’t about geography or scale, but about process design.

For small or midsized practices, even a single protracted enrollment can disrupt payroll or expansion plans. For hospitals and large health systems, backlogs scale into millions of dollars in deferred reimbursements each year. Poorly managed enrollment also leads to downstream issues — claims denied for provider ineligibility, payment resubmissions, and increased administrative overhead as staff chase down status updates. 

These hidden costs don’t appear on balance sheets, but they do weigh heavily on margins.

Delays and workforce shortages: the hidden connection

Long enrollment timelines slows both revenue and access to care. The states facing the most persistent payer enrollment delays are often the same ones struggling to recruit and retain clinicians. 

Looking at Health Professional Shortage Areas (HPSAs) — a federal designation issued by the Health Resources and Services Administration (HRSA) — identifies communities where access to care is limited because there aren’t enough providers to meet patient demand. These are the regions where every additional enrolled clinician can have an outsized impact.

In Michigan, Virginia and New York, for instance, payer enrollment timelines consistently exceed national averages. Each also carries hundreds of Health Professional Shortage Area (HPSA) designations — 766 in Michigan, 557 in New York, and a large share (430) across Virginia. In rural regions such as North Dakota, South Dakota, and Vermont, the overlap is even starker: thin provider supply, vast service areas, and enrollment cycles that stretch beyond 90 days.

The connection isn’t coincidental. In areas already under strain, fewer available staff, fragmented systems, and limited payer infrastructure all contribute to slower turnaround times. Every delay makes the shortage more visible. Fewer enrolled providers means fewer appointment slots, longer travel times, and growing pressure on the clinicians already practicing in those regions.

Scale and state variability matter 

Over a 12-month lookback period, Medallion analyzed payer enrollment data at the state level and found a consistent pattern: in large states and national networks, scale magnifies every delay. The same systems designed to ensure accountability — forms, validations, and data checks — can become bottlenecks when multiplied across millions of covered lives. What was meant to create order instead begins to slow progress.

High-membership states must process exponentially more enrollment files, each governed by its own compliance rules and system interfaces. When a single document error or data mismatch can stall hundreds of pending providers, even well-resourced teams struggle to keep up. Every additional verification step adds pressure, especially when staffing and bandwidth are already stretched thin.

The financial effects are just as steep. Enrollment may appear to be an administrative step, but it sits at the heart of a healthcare organization’s financial health. When clinicians aren’t enrolled, they can’t bill — and those delays translate directly into lost revenue. Based on provider billing data from a leading insurance payer, enrollment lags can cost an organization up to $1.9K per day, per provider in unrealized revenue.

For small and midsized practices, even one delayed enrollment can disrupt payroll or expansion plans. For hospitals and large health systems, backlogs scale into millions of dollars in deferred reimbursements each year, alongside denied claims, payment resubmissions, and rising administrative overhead.

And the larger the state, the higher the stakes. A 90-day delay in a smaller market like South Dakota may affect relatively few patients, but it can still mean over $200,000 in deferred revenue per provider. In populous states like Michigan or Texas, those same lags ripple through millions of covered lives, creating access barriers as well as financial strain.

Ultimately, scale doesn’t just multiply administrative work — it multiplies the consequences of inefficiency. What begins as a processing lag can become a structural access issue, proof that payer enrollment speed is as much a public health concern as it is an operational one.

Enrollment efficiency as a strategic lever 

Across Medallion’s dataset, one theme stands out: improvement is possible, and high-performing states share common behaviors. Organizations that move faster tend to treat enrollment not as paperwork but as a strategic capability — one that connects financial performance, patient access and provider satisfaction.

Among provider organizations, the most effective teams start by quantifying their time-to-revenue risk by state. They understand where delays cluster, how those delays affect ramp-up, and where process consistency can close the gap. By standardizing intake-to-submission workflows and negotiating service-level agreements with payers in high-delay markets, they translate data into predictable cash flow.

Payers, meanwhile, benefit from benchmarking themselves against national medians and top-performing peers. Many of the fastest states operate under delegated credentialing models or integrated data-sharing agreements. Those that provide transparency — allowing providers to see enrollment status in real time — report lower rework rates and stronger partner relationships.

Health systems play their part by using enrollment data to inform strategic planning. Expansion models that account for payer turnaround times lead to smoother market entries and faster provider onboarding. The most successful organizations also centralize provider network data, reducing fragmentation and errors. And at the policy level, collective advocacy remains essential. The industry’s associations can drive standardization of payer enrollment alongside the ongoing reforms in reimbursement and licensure.

In short, there is no single fix. But every incremental improvement — whether a clearer data handoff, an automated step, or a shared dashboard — moves the system closer to what it’s meant to be: a seamless path from provider readiness to patient care.

Final reflections

Improving payer enrollment isn’t just about faster approvals, it’s about aligning operations with access, revenue, and trust. With AI-assisted automation, Medallion turns payer enrollment delays into opportunities for speed, accuracy, and trust — aligning every approval with better access to care. 

Streamlining payer enrollment operations can present itself as challenging: causes vary across states and payers; progress depends on shared data, collaboration and constant iteration. And yet, it’s doable. Every efficiency gained compounds across providers, payers, and patients alike translating time saved into care delivered.

For a deeper look into the analysis and trends, visit Medallion’s report on the Geography of Enrollments here.