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Breaking it down.

Time and time again, we’ve noticed some confusion between credentialing and enrollment. And to a degree, the blurring between the two is completely justifiable. They overlap one another in numerous ways — making both processes seem complex in nature.

The overlap between credentialing and enrollment begins on a data level. Not only does much of the same data have to be reviewed by a lot of different people within an organization, but there is no standard process to acquire (or deliver) that information to the appropriate individuals. It can get downright messy!

Questions?

“Credentialing starts the lifecycle of the revenue cycle.”

Shelby Warren, Payer Enrollment Specialist

Prime Differences

Below is a list of the main differences between credentialing and enrollment.

  • Credentialing
  • Credentialing is the in-depth process of verifying a provider’s identity. A Certified Credentialer will review the providers qualification and career history which includes their education, training, residency, licenses, as well as any specialty certificates.
  • Credentialing
  • Credentialing is the start of the process. Once approved, enrollment will begin to link the providers to the payer. Think of it as building “credibility” with payers. Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text
  • Credentialing
  • Credentialing can take 30 to 160 days, whereas enrolling a provider with a payer can take 1 to 4 weeks. Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text Text
  • Enrollment
  • Enrollment links providers to payers, where contracts are already established so providers can get paid. Text text text text Text text text text Text text text text Text text text text Text text text text Text text text text
  • Enrollment
  • Enrollment and Credentialing are both time-consuming and while both consist of roughly the same amount of information, managing and maintaining a balance between the two is vital. Text text text text Text text text text Text text text text Text text text text.
  • Enrollment
  • As part of the enrollment process, a provider needs to be credentialed with a payer prior to the start of enrollment. Time is money so the sooner the information is provided, the sooner enrollment can begin. Text text text text Text text text text.

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