Nurse practitioners and other clinicians often send in questions about credentialing and contracting. It’s clear, from those questions that there is some confusion about the two and it’s important that all health care providers understand the difference.
Credentialing is a process where the company attempts to make sure that you are you. They want to make sure that you are an excellent health care provider, and that you don’t have any of the red flags swirling around your head.
What do I mean by that? Items of concern include malpractice claims, complaints against your license, lawsuits, loss of credentialing at other companies, addiction issues, and a whole host of other things.
I’m sure you are aware that insurances or third party payers are not the only companies that will put you through a credentialing process. You may find that you will need to be credentialed in order to work with a clinic, university or to be on staff at your local hospital.
Contracting – regardless if it’s insurance or employment contracting – it takes place after you have gone through the credentialing process and they have decided that you are a great provider for their patients. Keep in mind, contracts are not going to be offered to someone who does not meet the standards for a health care provider in their company.
Contracts outline the terms of the working relationship. In the case of insurance contracts, they will cover your responsibility to them and their patients. Additionally, they’ll tell you what they will do for you as well as what you’ll need to do in order to get paid and how much they will pay you. Because of this, you’ll want to negotiate the terms of your contract. And as always, read your contracts thoroughly before signing them.
So there you have it. Think of credentialing as a vetting process and contracting as the written terms of agreement.
I invite you to ask your questions or leave comments below about your own credentialing and contracting experiences.