Credentialing and billing are two distinct but closely related processes in healthcare revenue cycle management. Many practice owners — especially those launching a new practice or switching billing companies — confuse the two or assume that hiring a billing company automatically covers credentialing.
Understanding the difference is important because a gap in either process can directly affect your ability to get paid. This guide explains what each service involves, how they differ, when you need both, and how to find billing companies that offer credentialing support.
That means 38% focus solely on billing. If you need credentialing, verify it's included before signing.
What Is Medical Credentialing?
Medical credentialing is the process of verifying a healthcare provider's qualifications and enrolling them with insurance payers so they can bill for services. Without credentialing, a provider cannot submit claims to insurance companies — which means they cannot get paid for insured patients.
The Credentialing Process
CAQH Profile Setup
2-4 weeksCreate and maintain a universal provider profile used by most commercial payers.
Application Submission
1-2 weeks per payerSubmit enrollment applications to each insurance payer you want to bill.
Verification
30-120 daysPayers verify education, training, licensure, malpractice history, and work history.
Contract Negotiation
VariableNegotiate fee schedules and contract terms with each payer.
Approval & Enrollment
Immediate upon approvalReceive provider numbers and begin billing.
Credentialing is not a one-time process. Providers must re-credential with most payers every 2-3 years, and CAQH profiles must be re-attested quarterly. Failing to maintain credentialing can result in being dropped from insurance panels.
What Is Medical Billing?
Medical billing is the ongoing process of submitting claims to insurance payers, following up on unpaid claims, managing denials, posting payments, and collecting patient balances. It is the operational engine of your practice's revenue cycle.
The Billing Cycle
Charge Entry & Coding
Translating services into billable codes (CPT, ICD-10, CDT)
Claim Submission
Submitting clean claims to payers electronically
Follow-Up
Tracking unpaid claims and resolving issues
Denial Management
Appealing denied claims and preventing future denials
Payment Posting
Recording payments and reconciling accounts
Patient Billing
Collecting copays, deductibles, and patient balances
Key Differences
| Factor | Credentialing | Billing |
|---|---|---|
| Timing | Before you can bill | Ongoing, after credentialing |
| Frequency | Initial + every 2-3 years | Daily/weekly cycle |
| Duration | 90-180 days per payer | Continuous |
| Skills Required | Regulatory knowledge, documentation | Coding, claims, follow-up |
| Cost Structure | Per-provider fee ($300-1,500) | % of collections or flat fee |
| Who Performs It | Credentialing specialist | Billing team / coders |
| Consequence of Failure | Cannot bill insurance at all | Delayed or lost revenue |
When You Need Both
There are several situations where you need both credentialing and billing services, ideally from the same company for seamless coordination.
Launching a new practice
You need credentialing to get enrolled with payers before you can start billing. Having one company handle both ensures a smooth transition from enrollment to active billing.
Adding new providers
Each new provider needs to be credentialed with your contracted payers. A billing company that also handles credentialing can coordinate the timing so billing starts as soon as credentialing is approved.
Expanding to new payers
If you want to accept new insurance plans, you need to credential with those payers first. Your billing company can advise which payers are worth pursuing based on your patient mix.
Re-credentialing deadlines
Missing a re-credentialing deadline can result in being dropped from a payer's network. A company that manages both billing and credentialing will track these deadlines proactively.
Credentialing by Specialty
Credentialing requirements and processes differ by specialty. Here is what to know for each.
Mental Health
69 of 99 companies offer credentialingFocus on insurance panel enrollment for therapists, psychiatrists, and counselors. CAQH management is critical. Many mental health providers need to be credentialed with dozens of commercial payers plus Medicare and Medicaid.
Browse Mental Health billing companiesABA Therapy
28 of 36 companies offer credentialingMedicaid credentialing is particularly important for ABA providers, as Medicaid is a primary payer for autism services. State-specific Medicaid enrollment processes vary significantly and require specialized knowledge.
Browse ABA Therapy billing companiesDental
44 of 74 companies offer credentialingDental credentialing involves enrollment with dental insurance networks (Delta Dental, Cigna Dental, etc.). DSOs need multi-provider, multi-location credentialing which adds complexity.
Browse Dental billing companiesPhysical Therapy
54 of 72 companies offer credentialingPT credentialing includes Medicare enrollment (PECOS), commercial payer enrollment, and state licensure verification. Group practices need to credential each individual therapist.
Browse Physical Therapy billing companiesHome Health
30 of 52 companies offer credentialingHome health credentialing involves CMS certification, Medicare enrollment, state licensing, and accreditation (ACHC, CHAP, or Joint Commission). This is one of the most complex credentialing processes.
Browse Home Health billing companiesFinding Billing Companies That Offer Credentialing
If credentialing support is important to your practice, you can use our directory to find companies that offer both services. Our credentialing filter page shows all companies with verified credentialing capabilities.
When evaluating credentialing services, ask:
- Is credentialing included in the billing fee, or is it a separate charge?
- Do you handle initial credentialing, re-credentialing, or both?
- Do you manage CAQH profiles?
- How many payers can you credential with simultaneously?
- What is your average time to credentialing completion?