Credentialing verifies a provider's education, licenses, certifications and history. Payer enrollment (often included in the term) is applying to each insurer so the provider can bill it as in-network.
Claims for a provider who is not yet enrolled with a payer are usually denied, so enrollment delays directly delay revenue.
Related terms
- Claim denial
- A payer's decision not to pay a claim that it received and processed.
- Eligibility verification
- Confirming a patient's insurance is active and what it covers before the visit.
- Revenue cycle management (RCM)
- Everything a practice does to get paid for care, from scheduling to the final payment.