Telehealth companies lose revenue before first visits due to payer enrollment delays, credentialing backlogs & insurance paperwork.
Most telehealth founders expect their hardest problems to be clinical. Hiring the right providers. Building a product patients actually use. Getting unit economics to work. What they don’t expect is losing tens of thousands of dollars in revenue before a single appointment is booked, not because of anything clinical, but because of paperwork.
It happens at almost every virtual care company that scales past a handful of providers. And the mechanism is almost always the same: payer enrollment delays, credentialing backlogs, and the slow grind of getting providers recognized by insurance companies. By the time a provider is cleared to see patients and bill insurance, weeks or months of potential revenue have already evaporated.
This isn’t a minor operational inconvenience. For telehealth companies operating on thin margins with investor timelines, it’s a structural threat to the business.
Article Breakdown
The Clock Starts Before You’re Ready
Here’s how the problem unfolds in practice. A telehealth company hires a new provider. That provider can technically see patients on day one. But if they aren’t yet enrolled with a patient’s insurance plan, the company either has to see that patient out-of-pocket (which most patients won’t do), delay the appointment, or absorb the cost of a visit that can’t be billed.
Traditional credentialing and payer enrollment takes 60 to 120 days. That’s the industry baseline. During that window, a single provider generating $5,000 to $10,000 per month in billable visits represents $10,000 to $20,000 in delayed or lost revenue. Multiply that across 10 new hires in a quarter and the number becomes material fast.
The problem compounds when a company is expanding into new states. Every state has its own licensing requirements. Every payer has its own enrollment process, its own forms, its own review timelines, and its own quirks. A telehealth company expanding from three states to eight isn’t dealing with three times the complexity. It’s dealing with an exponential increase in administrative variables, most of which are still managed by fax, manual follow-up, and spreadsheets.
Why In-House Solutions Break Down at Scale
The instinct for most founders is to hire their way out of the problem. Bring on a credentialing coordinator. Maybe two. Build an internal team that owns provider onboarding end to end.
This works at small scale. It stops working the moment growth accelerates.
Credentialing specialists are expensive to hire and hard to retain. Training takes months. And the work itself, chasing down primary source verifications, monitoring provider licenses across multiple states, tracking payer-specific enrollment requirements, does not scale linearly with headcount. The administrative surface area grows faster than any team can cover it manually.
Healthcare organizations that rely on in-house credentialing teams routinely lose 60 or more hours per week to manual administrative work that should be automated. That’s not a staffing problem. That’s an infrastructure problem. The decision between building that infrastructure internally or outsourcing it is one of the most consequential operational choices a growing telehealth company makes, and most teams get it wrong early.
What the Revenue Leakage Actually Looks Like
The financial damage shows up in a few distinct ways that are easy to undercount.
The most obvious is delayed time-to-billing. When a provider can’t bill insurance because enrollment isn’t complete, every visit they see is either a write-off or a patient experience problem. Credentialing delays alone stall billing by 45 days or more on average. For a fast-growing telehealth company onboarding multiple providers per month, that lag stacks.
The less obvious damage comes from lapsed credentials. A provider who was credentialed two years ago needs to be re-credentialed. If that renewal is missed, and in a manual system renewals get missed constantly, the provider’s ability to bill can be suspended retroactively. Claims get denied. Revenue that was already recognized has to be reversed. The cost of a single missed renewal can exceed what it would have cost to automate the entire monitoring process.
Then there’s the opportunity cost of expansion. Telehealth companies that want to enter a new state can’t just flip a switch. Every provider needs state-specific licenses. Payer panels need to be opened. Enrollment timelines need to be managed. Companies that don’t have streamlined infrastructure for this end up delaying market entry by months, which means delayed revenue from an entire patient population.
The Shift Toward Automated Provider Operations
The companies getting this right aren’t necessarily bigger or better-funded. They’ve made a deliberate decision to treat provider operations as infrastructure rather than overhead.
That means moving away from manual credentialing workflows and toward platforms that automate primary source verification, track enrollment status in real time, and flag compliance issues before they become claim denials. It means integrating directly with sources like CAQH, NPPES, and state medical boards rather than having a human manually query each one. It means getting providers credentialed in days rather than months.
Platforms built specifically for this problem, like Assured (withassured.com), an NCQA-certified credentials verification organization, have compressed what used to be a 60-day process into as little as 48 hours by running primary source verifications in parallel across thousands of data sources. For payer enrollment, the same automation logic applies: automated submissions, real-time tracking, and proactive follow-up that doesn’t depend on a coordinator remembering to send a fax.
The result isn’t just speed. It’s first-pass approval rates. When enrollment applications are submitted with complete, verified data, they don’t come back with correction requests. They go through. That matters because in payer enrollment, a rejection often means restarting the clock entirely.
What Founders Should Do Before They Scale
The operational decisions that compound into revenue problems are almost always made early, when the stakes seem low. A founder who manually manages credentialing for five providers can get away with it. When that company hits 30 providers across six states, the same approach doesn’t just slow things down. It becomes the ceiling on how fast the business can grow.
The questions worth asking before scaling a provider network: How long does it currently take to get a new provider billable with all target payers? What happens when a license or certification expires and who owns that? Is there visibility into which providers have open enrollment applications and where each one stands? If the honest answers to those questions involve spreadsheets, email threads, and manual follow-up, the infrastructure isn’t ready for growth.
Telehealth was supposed to remove barriers between patients and care. The irony is that the biggest barriers aren’t clinical at all. They’re administrative. The companies that figure out provider operations early don’t just reduce costs. They unlock revenue that was always there, just stuck in the pipeline.
