Credentialing vs. Contracting: Is There a Difference? I am in-network and credentialed with the insurance company, but I’m not getting paid. What’s wrong?

This is a common concern I hear from providers, so let’s shed some light on the issue.

Credentialing is the process where you partner with an insurance company, providing them with your qualifications and information. In return, the insurance company lists you as an in-network provider, making your services available to their members. Think of it as establishing a professional network.

Contracting, on the other hand, is the agreement between you and the insurance company. You agree to treat their members, and in return, they agree to pay you a set amount for your services.

If you're joining an established group, often a contract is already in place, so you may only need to go through the credentialing process. However, if you’re a sole provider or starting out on your own, always begin with contracting. Once the contract is in place, credentialing will naturally follow.

This Q&A does not constitute legal, accounting, or tax advice and

does not address state or local law.