Difference between Provider Credentialing and Provider Enrollment

Hiring incompetent medical professionals can lead to increased risk of liabilities and malpractice suits on your reputed firm. To ensure that your practice doesn’t get affected by this problem, verifying credentials of the medical professionals is crucial. Failure to do so can lead to a negative impact on the reputation and a diminishing revenue cycle.

Moreover, under the regulatory requirements, your facility can also become a violator of the compliance violations standards of your country.

So, to ensure that credential and enrollment processes run smoothly, it is essential to understand the difference between the two.

What is provider credentialing?

The credential is the process of verifying the credentials of your employees, which in this case are the medical professionals. Your credential verifying experts will verify the credentials including licenses, training certificates, education, experience, past records and background check to name a few. The credential verifying experts will then ensure that the employee is fit to carry out his duties. If he is not, you will have the chance to either fire him or make him rectify the areas where he lags.

The same credentialing is done to validate the healthcare professionals when they join a private healthcare facility or a healthcare network. It is repeated on a yearly basis.

What is Provider Enrollment?

 Provider enrollment is the process where medical professional requests to join the health insurance network as a provider. The process includes requesting the participation, completing the enrollment form, submitting verified credentials and other relevant documents, and signing a contract. The same process is used to validate the provider in a public health plan and to send approval to the billing agency.

Why is medical credentialing important?

Credentialing of a doctor/physician allows the practice to ratify that the professional wasn’t involved in any unhealthy activities. The credentialing process is time taking and is better done by credentialing experts. A practice, if itself, starts the credentialing process of the medical profession, it will waste a lot of time in reaching the right people for the document verification.

But, a credentialing expert is aware of all the difficulties faced during the process. Not only they pass through them easily, but they also have a network of people including inside government sources that help them do their jobs faster and get quick verification of the professional so he can start working.

The sooner he joins the firm, the sooner he will be able to help the health facility earn more revenue.

Why enrollment in healthcare network important?

The healthcare network is a pool of doctors that help the other medical professionals especially the juniors to get a ground faster. By enrolling in a medical network, the young doctors who are just starting out their careers will have a better chance of moving up the ladder swiftly.


Medical credentialing and enrollment both are crucial for doctors and medical facilities. First, saves the practices from professionals involved in malpractices and second helps professionals make relevant connections and widen their circle.

The medical billing services provide both medical credentialing and medical enrollment facility to the medical practices. Verify credentials of your professionals today, use our seamless medical credential verifying process.



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