Clarity RCM will be at the ADA-M Annual Meeting in Chicago this week (Feb 26-28). Swing by table 18/19 in the Imperial Ballroom to say hi, enter our JBL speaker raffle, or grab an Owala water bottle.

You hired a dermatologist! Signed the contract in March with a start date in June. You're thrilled.

But you didn't start credentialing until April, and now it's August and Aetna still hasn't returned your calls. That provider has been seeing patients for two months with no way to bill their three largest payers. Your monthly overhead didn't pause, but your revenue did. 

This is the most expensive mistake in practice management… and it usually stays invisible until the hole is already deep. 

A medical dermatologist generates $1.3 million in annual revenue on average. That's $108,000 a month. A 90-day credentialing delay on a single physician means $325,000 in revenue your practice will never recover.  

Not "delayed" revenue, just gone.

Here's why. CMS cut its retroactive billing window from 27 months to just 30 days in April 2021. Most practice managers still think they have months of runway to bill backward. They don't.

And commercial payers are worse. UnitedHealthcare, Aetna, BCBS, Cigna, and Humana do not allow retroactive billing as standard policy. BCBS explicitly states effective dates will not be backdated. Humana introduced a 30-day mandatory waiting period in June 2025, even after your documentation is complete. Services rendered during that window? Out-of-network rates. No retroactive fix.

So every day a provider sees patients without active credentials, you're stacking up claims that will never get paid. Layer in timely filing limits (90-180 days depending on the payer) and you've created a permanent revenue dead zone.

Aetna's credentialing process looks reasonable on paper. In practice, it runs through three separate departments (contracting, credentialing, network management), and the real timeline is 5-7 months.

And NCQA just made things tighter. The 2025 standards update, the largest credentialing overhaul in 20 years, shortened verification windows from 180 to 120 days for accreditation and 120 to 90 days for certification. Monthly monitoring of all credentialed providers is now required.

Payers are getting slower. Regulators are getting faster. That gap is where your money disappears.

Here's where it compounds. The dermatology PA workforce has grown 97% since 2013. PAs and NPs now make up nearly 25% of the derm clinician workforce.

The problem: PA turnover runs 10.7% annually, NPs at 15.3%, both roughly double the physician rate of 7.1%. Every departure and replacement triggers a full credentialing cycle. If you have four mid-levels turning over at industry averages, you're running one or two credentialing events per year just from churn.

Each one carries that same $42,000-$71,000 per month revenue risk. And 85% of credentialing applications contain errors that trigger delays. With 52% of credentialing teams still entirely manual, errors aren't the exception. They're the default.

You hire a new provider in August. Credentialing takes the typical 90-120 days. They're not fully paneled until November or December.

Sure, they can see cash-pay and cosmetic patients in the meantime — many practices use that as a bridge. But they can't bill a single insured medical visit to their three largest payers. And Q4 is when patients rush to use remaining FSA/HSA dollars and book appointments before deductibles reset. Those patients are picking in-network providers. If your new derm isn't credentialed, that volume goes down the hall.

When you're ready for an expert to make your practice's billing bulletproof, schedule a strategy call with our team.

This one was super fun. Hope you enjoyed it too.