What's the difference between Credentialing and Contracting a Provider?

Why This Topic Matters

Understanding these administrative processes affects whether a practice can be added to payer panels, how reimbursement arrangements are established, and how quickly a new provider can begin billing. The article is relevant to practices evaluating outside help for credentialing or contract negotiation and to teams trying to improve revenue cycle performance and administrative efficiency.

Article Sections

1. What Is Credentialing?

   Introduces the credentialing process and the type of provider information it involves. It explains the broad purpose of verifying qualifications within payer-related workflows.

2. The Credentialing Process

   Describes how credentialing is typically handled and the administrative steps involved. It also references database verification and the relationship to payer rostering.

3. Contracting versus Credentialing Providers

   Compares the two administrative processes and explains how they differ in payer relationships. The section also discusses group agreements and the general role of fee schedules.

4. Is it a Good Idea to Outsource Credentialing?

   Reviews the practical advantages and disadvantages of outsourcing credentialing services. It focuses on workflow, oversight, and operational considerations for practices.

5. Is it a Good Idea to Outsource Contracting and Contract Negotiation?

   Discusses outsourcing payer contracting and negotiation support. It addresses general considerations for selecting a negotiation service and evaluating its approach.

6. What is a Fee Schedule and Why is it Important?

   Explains the fee schedule as part of payer agreements and its role in reimbursement structure. It also discusses general contract-review concerns and timing considerations.

7. Other Benefits of Outsourcing your Credentialing and Contracting

   Summarizes broader operational benefits of efficient credentialing and contracting workflows. It connects these processes to practice reputation, cash flow, and access to payer panels.