Constant credentialing and provider purges: The hidden crisis for physicians and other clinicians in U.S. health care

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What began as streamlined provider credentialing has morphed into a bureaucratic maze that’s quietly determining who can practice medicine — and where patients receive care.

For example, a reminder to update a provider profile from organizations like the Council for Affordable Quality Healthcare (CAQH) goes unnoticed by a physician. Three months later, when longtime patients start calling about their insurance no longer covering visits, the physician finds out they have been dropped from multiple networks, not for quality issues but for missing a paperwork deadline.

The solution that’s the problem

Olga Khabinskay
_{© WCH}

The CAQH created CAQH ProView to eliminate redundant credentialing paperwork. Instead of filling out dozens of applications for different insurers, providers could submit information once to a central database.

Brilliant on paper. In practice? Over 2.5 million health care providers are now tethered to a system demanding reverification every 120 days. Miss that deadline, and your profile goes dark — invisible to insurance companies reviewing network participation.

The consequences ripple outward. Providers get locked out of networks. Patients lose trusted doctors. The inefficiencies CAQH was meant to eliminate get worse, not better.

The ‘pandemic’ of compliance

Industry experts describe CAQH attestation as a “pandemic” of compliance demands. Every U.S. provider now requires a CAQH ID for insurance credentialing, demanding attestation every four months without exception. When insurers check compliance, nonattested providers face immediate termination — no warnings, no grace periods, just sudden removal.

The enforcement is ruthlessly mechanical. Physicians and other clinicians get dropped regardless of circumstances: vacation schedules, illness, staff turnover or practice changes. The system assumes complete provider responsibility, treating any lapse as grounds for immediate contract termination. Insurance companies simply drop noncompliant providers and notify them after the fact.

This creates a devastating cycle. Once dropped, providers must restart the entire credentialing process — typically three months — assuming the insurance panel remains open. During this period, they cannot see covered patients or receive payment for services. The financial and professional impact is immediate and severe.

Insurance companies didn’t initially weaponize CAQH compliance, but power dynamics have shifted dramatically. Dropping noncompliant providers offers a convenient way to control network sizes and costs. It’s easier to point to missed deadlines than admit you’re shrinking networks for profit.

Health care is already stretched thin, between physician shortages, nurse burnout and specialists booking months out. Yet providers are getting dropped for paperwork errors. The situation has become so critical that maintaining accurate CAQH files is now a top priority, with many practices turning to specialized recredentialing services to avoid devastating attestation lapses.

The real victims

Mental health providers, already scarce and desperately needed, find themselves caught in this compliance web. A therapist might spend three hours setting up their CAQH profile, then face quarterly updates for information that rarely changes. Skip one cycle, and patients who’ve been seeing that therapist for months discover sessions are no longer covered.

For solo practitioners and small practices, the burden feels crushing. They’re trying to heal people while playing high-stakes bureaucratic compliance. Large health systems hire dedicated credentialing staff. Independent physicians and other clinicians handle it themselves, squeezed between patient appointments and family obligations.

Patients rarely hear about CAQH directly but feel its effects constantly. When their trusted family doctor suddenly becomes out of network, it’s often because of compliance issues, not quality concerns. Provider directories get outdated quickly due to attestation lapses, leading patients to book appointments with doctors who aren’t actually available.

The downstream effects multiply. Patients in underserved areas lose access to even more doctors. Those who can afford it pay out of pocket to continue seeing dropped providers. Others scramble to find new doctors, facing weeks or months of appointment delays.

For patients with chronic conditions, provider continuity matters enormously. Breaking those relationships over paperwork compliance creates real health risks that never show up in CAQH’s efficiency metrics.

Surviving the system

As a result, providers navigating CAQH attestation must treat it like any critical business process.

• Set calendar reminders for every 115 days — don’t wait for the 120-day deadline. CAQH sends email notifications, but these get buried in daily health care communications.
• Double-check every detail before attesting. License numbers, practice addresses, specialty certifications — all need current accuracy. A single typo can trigger delays, taking weeks to resolve.
• Small practices should consider outsourcing CAQH management to specialized credentialing services. For solo practitioners juggling patient care with business management, it’s frequently worth the investment.

Technology that isn’t enough

CAQH has invested in artificial intelligence and automated data validation, promising to catch errors before they cause problems. They’ve launched provider advisory councils and CAQH University training programs. These are positive steps, but they haven’t solved the fundamental issue: a system that punishes human error in an already overwhelmed health care workforce.

The 2024 Change Healthcare cyberattack illustrated health care’s digital fragility. Provider payments got disrupted for months, highlighting centralized system risks. When CAQH has technical issues, providers can’t update information even when trying to comply.

What’s really at stake

The CAQH attestation crisis reflects broader health care tensions — the endless pursuit of administrative efficiency colliding with messy medical practice realities. CAQH’s mission to reduce redundant paperwork is noble. But rigid compliance requirements are pushing providers out of networks at exactly the wrong time.

Health care needs better data management and streamlined credentialing. But it also needs to recognize that providers are humans managing complex practices, not data entry machines. When missed attestation deadlines carry the same weight as medical malpractice, priorities have gone seriously wrong.

The path forward requires compromise. CAQH could extend attestation periods, provide better notifications, or create grace periods for technical issues. Insurance companies could implement more nuanced compliance policies. Regulators could examine whether current enforcement actually serves patients’ interests.

Most importantly, the health care industry must remember that administrative efficiency means nothing if it prevents patients from accessing care. The goal should be supporting provider-patient relationships, not creating new barriers.

The bottom line

Change is coming, though not fast enough for providers currently caught in the CAQH maze. Real-time data exchange and better interoperability might eventually reduce quarterly attestation needs. Artificial intelligence could automate compliance burdens.

But technology alone won’t fix the fundamental problem: a health care system prioritizing process compliance over patient access. That requires human judgment, policy changes and recognition that the most efficient administrative system is useless if it prevents sick people from seeing doctors.

For now, providers must stay vigilant about CAQH compliance while advocating for sensible policies. Patients should understand that network disruptions often reflect administrative failures, not provider quality issues. And everyone in health care should remember the ultimate goal isn’t perfect data management — it’s helping people get better.

The system isn’t completely broken, but it’s bending under bureaucratic weight. Whether it adapts or breaks depends on stakeholder willingness to prioritize patients over paperwork. The clock is ticking, and unlike CAQH attestation deadlines, this affects everyone.

Olga Khabinskay is director of operations at WCH, a national health care practice management services company that provides billing, coding and credentialing as well as provider technology services.