The Provider Enrollment And Credentialing Cost Problem Most Payer CFOs Haven’t Fully Quantified

InnovationThe Provider Enrollment And Credentialing Cost Problem Most Payer CFOs Haven’t Fully QuantifiedByTammy Hawes,Forbes Councils Member.for Forbes Technology CouncilCOUNCIL POSTExpertise from Forbes Councils members, operated under license. Opinions expressed are those of the author. | Membership (fee-based)May 15, 2026, 06:15am EDTTammy Hawes is VP, Payer Credentialing and Compliancy at HealthStream, following the acquisition of Virsys12 in October 2025. getty​Administrative efficiency is a perennial focus for payer chief financial officers (CFOs) and for good reason. Administrative costs represent roughly 15% to 25% of total U.S. healthcare expenditure, as reported in the medical journal JAMA. These estimates have drawn sustained attention from regulators, employers and policymakers alike. Yet within that broad category, one cost driver consistently evades precise quantification: the cascading financial impact of fragmented provider data.This is not because the costs are small. It is because they are distributed, spread across credentialing operations, compliance functions, IT infrastructure and network management in ways that make them difficult to aggregate on a single budget line. That diffusion makes the costs easy to underestimate. It also makes them easy to tolerate longer than is financially rational.The most expensive administrative costs are often the ones that look like normal operations until you build the infrastructure to see them clearly.Where The Costs Actually LiveFor health plans operating with fragmented provider data environments, the costs accumulate across several distinct domains.Redundant Verification And Reconciliation Labor ​When provider data is maintained independently across credentialing, claims, directory and network management systems, each system's data will diverge over time. License updates, address changes, specialty additions and affiliation changes are captured inconsistently across platforms. The result is a persist...