2025 Provider Credentialing Guide: Avoiding AI-Driven Denials and Enrolment

Description

In 2025, provider credentialing is no longer a background administrative task—it’s a frontline battleground affecting payments, compliance, and the very survival of healthcare organizations.

With insurance companies streamlining their internal teams, removing traditional provider support lines, and outsourcing credentialing departments to third-party vendors, the process of becoming—or remaining—a participating provider has become increasingly unpredictable. Payers are taking longer to respond, often extending timelines far beyond what is published, and issuing blanket denials without clear reasoning or appeal instructions. At the same time, practices are expected to continue rendering services while facing increasing risks of non-payment, audit exposure, and even contract termination.

Compounding the issue is the rapid adoption of Artificial Intelligence (AI) by major insurance companies. AI is now being used not only to audit provider charts and claims but also to proactively assess “risk scores” that can trigger silent credentialing denials, delays, or even removals from networks. These AI-driven decisions often happen without notice, without peer review, and without any opportunity for correction or escalation. For providers and credentialing professionals, this shift marks a dangerous turning point, where being accurate and compliant is not enough if you're also not aware of what data insurers are tracking.

This webinar will examine the latest trends and challenges in provider credentialing and enrollment, including:

• Extended credentialing timelines and how to plan for delays that go well beyond 90–120 days
• Unreachable payer support teams: What to do when no one answers the phone or replies to follow-ups
• Contract denials without justification and how to build defensible appeal records
• The role of peer review in modern credentialing and how insurers use it to delay onboarding or flag providers
• Billing risk when credentialing is delayed but claims are submitted: What is safe vs. what creates legal exposure
• A growing disconnect between provider submission and payer processing systems, especially when third-party vendors are involved
• Medicare enrollment bottlenecks, revalidation challenges, and the consequences of missed deadlines
• How AI is now controlling network participation, reimbursement policies, and audit targeting—and what providers can do about it

We will also explore solutions and proactive strategies, including:

• Tools and methods to track and document credentialing efforts
• How to escalate credentialing issues when payer communication channels have collapsed
• Building internal workflows that combine billing, credentialing, and compliance visibility
• Using data and reporting to protect against AI profiling and algorithm-driven exclusions
• Ways to monetize credentialing services if you're a billing company or MSO seeking to grow revenue and deliver more value to providers

This session is designed for:

• Credentialing managers and specialists
• Medical billing and RCM professionals
• Practice administrators
• Compliance officers
• Healthcare consultants and MSOs
• Independent providers seeking to better understand the credentialing landscape

Whether you’re trying to get new providers enrolled, respond to a puzzling denial, or simply make sense of why applications are stuck in limbo, this webinar will give you the insights, tools, and real-world examples you need to stay ahead in an increasingly complex, AI-driven credentialing environment.Learning Objectives

• Identify current trends and policy changes impacting provider credentialing, including Medicare enrollment delays, payer denials, and extended application timelines.
• Recognize the risks associated with credentialing delays, including billing disruptions, non-payment, audit exposure, and provider compliance violations.
• Understand how insurance companies are using AI to automate audits, assess provider risk, and make credentialing decisions without direct communication.
• Implement strategies to manage credentialing barriers, such as unreachable payers, missing escalation channels, and outsourced customer service models.
• Use documentation and tracking tools to monitor credentialing progress, support appeals, and defend against denials or payer inaction.
• Develop workflows that align billing, credentialing, and compliance teams to minimize payment risks and improve internal efficiency.
• Apply best practices to monetize credentialing services and scale them as a revenue-generating function within a billing or MSO business.
• Prepare for the future of credentialing oversight, including peer review triggers, audit trends, and payer AI profiling that may impact network participation.

Areas Covered

• Enrollment & Credentialing Delays
• Contract Denials & Communication Breakdowns
• Billing & Reimbursement Risks
• Provider Compliance & Peer Review Challenges
• AI-Driven Credentialing Controls
• Proactive Strategies & Tools.

Background

Credentialing and enrollment are no longer routine back-office tasks — in 2025, they’re the frontline of provider survival.

In this fast-paced and urgent session, we explore the most pressing challenges affecting provider enrollment and credentialing today. From Medicare’s shifting requirements and application timelines that stretch months past expected deadlines, to payer denials with no clear reasoning, the enrollment process is becoming a serious threat to provider revenue and network participation.

We'll also examine how insurance companies are increasingly using AI to flag, delay, and even terminate providers — all without ever speaking to a human. With many payers eliminating or outsourcing customer service functions, your ability to escalate, appeal, or even get updates is disappearing.

This webinar will equip you with:

• The latest trends and policy shifts impacting provider credentialing in 2025
• How enrollment delays are tied to claim denials and payment disruptions
• Strategies to manage peer review requests, credentialing audits, and contract rejections
• Real-world examples of payer behavior shaped by AI algorithms
• What providers, billing teams, and compliance officers must do now to protect network participation
• Proactive tools for tracking applications, handling escalations, and documenting payer inaction

Whether you’re a credentialing specialist, billing manager, or healthcare executive, this webinar will help you stay ahead of the chaos.

Why Should You Attend

• A clear understanding of how enrollment issues directly impact reimbursement and audits
• Tools to track applications and escalate unresolved cases
• Strategies for dealing with peer reviews, pre-payment flags, and silent denials
• Insight into how AI is reshaping credentialing risk — and what data insurers are watching
• Actionable steps to protect your practice’s participation and cash flow

Who Should Attend

• Practice manager
• Credentialing specialist
• Credentialing manager
• Billing manager
• Practice administrator
• Front desk manager.Speaker: Olga KhabinskayOlga Khabinskay, Director of Operations, WCH Service Bureau, Inc., and Manager of the Credentialing Department. For over 23 years, Olga has been servicing the healthcare industry for providers by helping with their insurance credentialing and contract challenges. She has been an advocate and educator for healthcare rights when it comes to closed panels, negotiation, and reinstatement. Product initiator and manager of CredyApp - an independent platform developed for billers by billers to streamline the credentialing process, manage daily credentialing tasks, streamline payer enrollment workflows, and improve operational control.

Olga is a member of the American Medical Billing Association (AMBA), American Health Information Management Association (AHIMA), American Association of Professional Coders (AAPC), Professional Association of Healthcare Office Management (PAHCOM) and Health Care Compliance Association (HCCA). Currently, she is an HBMA Payer Relations Committee Chair, HBMA Board of Directors, and a CAQH CORE Subgroup Team Member.

She graduated with a B.A. degree in Communication and Science from Adelphi University and received her master’s in healthcare management.

After Registration:Once you register, you will receive a confirmation email with login credentials and access to presentation materials. These resources are downloadable and may be shared with team members at your location for training.

System Requirements:

● Internet: A stable internet connection with a speed of at least 1 MBPS is recommended.

● Audio: A functioning headset or speaker with a microphone is encouraged for interactive sessions and a clear audio experience.

Session Cancellation Policy:

If for any reason ConferencePanel must cancel or reschedule the session, registered participants will be notified via email no later than 24 hours before the session start time.

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What Attendees Are Saying:

“ConferencePanel's webinar was well-organised and delivered practical insights our clinical team could act on immediately. The speaker was engaging and addressed all our concerns during the Q&A session.”– Laura M., Compliance Officer, Regional Healthcare System

“I appreciated how easy it was to join and follow the session. The materials provided were professional and informative, and I was able to share them with my entire billing staff.”– Raj D., Revenue Cycle Manager, Private Practice Group