Impact of AI in Medical Credentialing and Payor Enrollment
Artificial Intelligence (“AI”) is the hot topic across nearly every industry, often accompanied by bold claims that it will “change the way we work” or even “make humans obsolete.” Healthcare is no exception. But anyone who works in this field knows two things: 1) healthcare is incredibly broad — there is no one-size-fits-all AI solution, and 2) the industry is already complex and becoming more so every year. This raises two important questions: How will AI meaningfully impact credentialing and enrollment, and when will that impact actually arrive?
Many clients ask, “Why should I hire you? AI can do this for less.” While we believe AI will eventually play a meaningful role in credentialing and enrollment, today’s systems are nowhere near ready to manage the full complexity of getting a provider credentialed and enrolled with payors. Below are three reasons why relying solely on AI is risky — and why expert oversight still matters.
1. Credentialing and Enrollment Are Complex, Non-Standardized Processes
AI systems perform best in structured, predictable environments. Credentialing and especially payor enrollment are anything but. Every payor has its own process. Some use online portals. Some require emailed PDFs. Some still rely on fax. Requirements vary widely, documentation is inconsistent, and published instructions are often outdated. This lack of standardization makes the landscape extremely difficult for AI tools to navigate reliably.
Modern AI models don’t adapt themselves over time — they don’t “learn” from mistakes or update their understanding based on new experiences. Any improvement requires humans to retrain or reconfigure the system. In a chaotic environment like payor enrollment, that means errors are likely unless experts are actively supervising and refining the process. Currently, there isn’t a lot of attention from experts in the credentialing and enrollment world on developing these AI tools, so most of these systems are still in their early stages.
2. AI Is "Garbage In, Garbage Out" — and Mistakes Are Costly
AI systems rely on the information they were trained on and the data they’re given. If the inputs are incomplete, outdated, or inconsistent, the outputs will be too. In credentialing and enrollment, the stakes are high. A single incorrect field, missing attachment, or outdated form can delay approval for weeks or months. Because payor responses are usually slow and often manual, the feedback loop is long. If an AI-generated application contains an error, you may not discover it until the payor rejects it.
That delay directly impacts revenue, cash flow, and patient access. This is why expert review, validation, and correction remain essential. AI can accelerate parts of the workflow, but it cannot replace the judgment and experience required to ensure accuracy.
3. Service Companies Will Benefit First From AI — but Providers Can Still Win
The organizations best positioned to leverage AI today are those already specializing in credentialing and enrollment. Companies like National Integrated Healthcare Group understand the nuances of each payor, the common pitfalls, and the operational realities that AI alone cannot yet manage.
By combining deep expertise with carefully deployed AI tools, we can streamline internal workflows, reduce manual repetition, catch errors early, improve turnaround times, and deliver a smoother experience for providers. This hybrid approach — AI plus expert oversight — is where the real value lies today.
So, What’s the Right Approach for My Practice?
Tools like ChatGPT, Copilot, and Gemini are impressive, but they are not turnkey credentialing solutions. Relying on them alone introduces unnecessary risk to your revenue cycle. Partnering with experienced credentialing professionals remains the safest and most effective path. AI will continue to evolve, and its role in this space will grow. But the organizations already immersed in credentialing and enrollment are the ones best positioned to harness AI responsibly and deliver meaningful results for providers.
At National Integrated Healthcare Group, we’re committed to using AI thoughtfully — not as a replacement for expertise, but as a force multiplier that enhances accuracy, efficiency, and client outcomes.