Credentialing delays have long been a quiet drag on health plan network performance. A new deal signals the industry is starting to address the problem at a different scale.
Medallion, a San Francisco-based AI-assisted credentialing and enrollment platform, acquired Andros, a National Committee for Quality Assurance (NCQA)-certified credentials verification organization. Andros has served health plans, health systems, provider groups, and telehealth companies since 2013. The combined platform now covers more than one million providers across nearly 400 healthcare organizations and health plans, according to Medallion.
When credentialing stalls, employer-sponsored plans end up with thinner networks than their directories suggest. Employees who cannot find an available in-network provider face out-of-pocket cost exposure, and the resulting member complaints typically surface at renewal.
Medallion's own 2026 State of Payer Enrollment and Medical Credentialing report, based on responses from more than 550 healthcare leaders, puts a number to the delay cost. Among hospitals that could quantify the impact, one in five reported losing more than $1 million annually from delayed provider activation. The pattern they describe - credentialing backlogs limiting network capacity - is one benefits advisers encounter when plan directory accuracy becomes a dispute point at renewal.
Medallion's own 2026 State of Payer Enrollment and Medical Credentialing report, based on responses from more than 550 healthcare leaders, puts a number to the delay cost. The report found that one in five hospitals able to quantify the impact reported losing more than $1 million annually from delayed provider activation.
What gives the problem independent standing is regulatory. NCQA updated its credentialing standards effective July 1, 2025, cutting maximum verification timelines from 180 days to 120 days for accredited organizations and introducing mandatory monthly monitoring of all enrolled providers. Organizations currently failing 2026 NCQA review cycles are being cited specifically for non-compliance with those new requirements.
The Andros acquisition is an attempt to bring credentialing infrastructure under a single AI-driven platform. Andros contributes NCQA certification and 13 years of health plan relationships. Medallion's platform handles primary source collection and provider outreach through automation, with credentialing specialists stepping in when the system flags exceptions. Andros customers will move to Medallion over time, with access to real-time status tracking alongside the automated workflow.
The deal also shows a gap in where AI investment has gone in healthcare. According to Medallion's January report, only 12 percent of AI investments touch credentialing or enrollment, with most resources directed at clinical and patient-facing functions. That concentration has left the administrative infrastructure underpinning network accuracy largely manual. The consequences show up in plan performance data that benefits advisers can examine at renewal.
Outdated or incomplete credentialing creates the conditions for ghost providers: practitioners listed as in-network who are unavailable or no longer affiliated. Regulators have flagged ghost networks as a compliance risk, and employees encounter the problem when their coverage does not work as described. As recent coverage of provider data errors across health systems and health plans found, fewer than one in three health systems maintains a single verified source of truth for provider data. Those errors cascade into the AI-driven claims and network management functions health plans are actively investing in.
That backdrop is why AI adoption across health plans without matching governance infrastructure compounds the credentialing problem rather than solving it. A platform that keeps provider records current at scale addresses a problem upstream of where most AI spending is currently focused.
Financial terms were not disclosed. Bailey & Company served as exclusive financial advisor to Andros.
