Terms like credentialing, contracting, group enrollment and individual enrollment get thrown around constantly. Once you separate them, it all starts to make sense.
Credentialing: the approval stage
Insurers verify your education, licensure, training, work history, liability insurance and background before you can join a panel.
Contracting: the agreement
Once approved, you sign a contract that sets reimbursement rates, billing procedures, covered services and compliance requirements. You're not in-network until the contract is executed and you have an effective date.
Individual or group?
An individual contract belongs to you and travels with you. A group contract belongs to the business and is not portable, but it gives the practice more control and, sometimes, better leverage. Many payers require a minimum number of providers before offering a group contract.
We help you choose the right structure for your goals before a single application goes out.