What Shared Credentialing Actually Changes (And What Stays on Your Desk)

On September 23, CertifyOS announced a National Shared Credentialing Program with UnitedHealthcare, Cigna Healthcare and Centene as initial participants. Providers submit once, through one portal. CertifyOS performs primary source verification to NCQA and state Medicaid standards. Participating payers accept that determination rather than each conducting their own review.

If you have spent any time in credentialing, your first reaction was probably relief, followed immediately by a more complicated question: what does this mean for the work I do?

This article is an attempt at an honest answer, including the parts that are good news and the parts that are unchanged.

What the program actually does

The redundancy it targets is real and well documented. The US spends more than $2 billion a year verifying provider credentials. Industry estimates put up to 75% of that down to duplication — the same license checked by the same method by a dozen different organizations. Health plans spend $200 to $500 per provider per recredentialing cycle doing it.

A provider joining three networks today has their medical school verified three times, their license verified three times, their sanctions history checked three times. Under a shared model, once.

That is a genuine improvement, and it is the kind of infrastructure the field has wanted for two decades.

What it doesn't change

Here is where it is worth being precise, because the coverage has not been.

The payers not in the program. Three participants, however large, are three. A practice managing participation across Medicaid programs, regional Blues plans, behavioral health networks, IPAs and workers' compensation carriers still has the same number of relationships as before, minus the duplicate verification among three of them.

Enrollment is not credentialing. This is the distinction that gets lost in every conversation about credentialing automation. Verification confirms a provider is qualified. Enrollment establishes that they can bill a specific payer under a specific contract with a specific effective date. Shared verification addresses the first. The second still involves applications, follow-ups, effective dates and the phone call where you find out something was missing.

Expirables. Licenses expire. DEA registrations expire. Malpractice coverage renews. Board certifications lapse. These run on their own calendars, independent of any payer, and someone has to be watching all of them. A shared verification network does not tell you that a physician's coverage lapses in forty days.

Re-credentialing cycles. Each payer's clock keeps running on its own schedule, one, three or five years from its own effective date.

Client reporting. If you are a billing company, your clients still want to know where things stand, and they want it in a format you can produce quickly.

Ownership. A payer requests additional information on a Friday afternoon. The person who submitted the application is out. Where does that request go, and who owns it on Monday? No verification network answers that question.

The constraint doesn't move

We have written before that most credentialing operations fail for a reason that has nothing to do with credentialing knowledge. The team knows the rules. What breaks is capacity — how much state a team can reliably hold at once — and continuity, which is what happens to in-flight work when a person is unavailable.

Shared verification reduces work. It does not change which kind of work is the bottleneck.

If your team currently cannot answer "how many documents expire in the next 45 days" without building the list, that will still be true after the program launches. If a payer request can sit unowned for nineteen days, it can still sit unowned for nineteen days.

The honest framing is that this removes a cost from payers and some administrative repetition from providers. It is not an operational redesign for the people managing credentialing day to day.

What to watch before you plan around it

Three things are not yet knowable, and anyone telling you otherwise is guessing:

Whether the commitments are binding. The announcement names three payers as initial participants but does not describe the commercial nature of those commitments.

Scope of the first rollout. How many providers, which plans, which specialties. Not stated.

Whether it holds. Medallion announced CredAlliance in August 2025 as the first national credentialing clearinghouse for payers, describing it as already live with several major national payers. Shared credentialing infrastructure has been announced before. Announcement and adoption are different things.

The service is planned for fall 2026. There is no outcome data because there has not yet been an outcome.

What this means practically

For most teams: nothing this quarter. There is nothing to enroll in yet.

What is worth doing is managing the expectation. If leadership or clients have read the coverage and concluded that credentialing is about to become automatic, that gap between expectation and reality will land on your team in about six months. Better to set it correctly now.

And if your operation's plan for handling growth was "wait for the industry to fix this" — it is worth noticing that the industry just fixed a real thing, and your Monday looks the same.

That should tell you where the constraint actually is.

See what your operation's constraint actually is. Start a 30-day free trial: https://credyapp.com/Identity/Account/RegisterDemo — no setup required — or schedule a consultation: https://credyapp.com/Webinar/.

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