If you are a healthcare provider whether in primary care, specialty care, a mental health or substance abuse facility, or any other healthcare group; getting paid by insurance companies isn’t just about delivering great care or submitting clean claims. Long before reimbursement ever hits your bank account, there are three critical processes that must be completed and completed correctly:
- Insurance Credentialing
- Contracting
- Paneling
These terms are used interchangeably, even by experienced staff, but they are not the same thing. In fact, confusing them, or skipping a step entirely, is one of the most common reasons primary care practices experience delayed payments, denied claims, and months of lost revenue.
In this guide, we will break down credentialing vs contracting vs paneling, explain how each process works, how they fit together, and what every primary care practice should be doing to protect cash flow and avoid unnecessary billing headaches.
👉 If you would rather have an expert handle this for you, you can always reach out to the BillVolt team for support.
Why This Matters So Much for Healthcare Providers Across All Specialties
Healthcare practices, regardless of specialty, operate on tight margins. You are managing complex patient care, high volumes, specialized treatments, care coordination, and detailed documentation frequently with a lean administrative team.
When credentialing or contracting isn’t handled properly, the consequences can be serious:
• Claims get denied as out of network
• Payments are delayed for weeks or months
• Patients are billed incorrectly and demand refunds
• Trust and credibility with patients suffer
• Staff time is wasted fixing avoidable issues
Simply put, understanding and managing these processes protects your revenue, your compliance, and your patient experience.
👉 If billing uncertainty is slowing your practice down, it may be time to review how your payer enrollment is being handled.
What Is Insurance Credentialing?
Insurance credentialing is the process insurance companies use to verify that a provider is qualified, licensed, and eligible to treat their members.
During credentialing, payers review and confirm details such as:
- Active medical license
- Board certification (if applicable)
- DEA registration
- NPI (National Provider Identifier)
- Education and training history
- Work history
- Malpractice insurance coverage
- Any sanctions or exclusions (OIG, SAM, etc.)
At its core, credentialing answers one simple question:
“Is this provider qualified and allowed to care for our members?”
One Missing Document Can Stall Your Revenue for Months.
Don’t let an outdated CAQH profile or a missed deadline keep you out of network. BillVolt’s credentialing experts handle the paperwork and follow-ups so you can focus on your patients.
Key Facts About Credentialing
- Credentialing applies to individual providers as well as group healthcare facilities and clinics
- It typically takes 45–120 days depending upon the payer.
- Credentialing must be completed before contracting or paneling can move forward
Common Credentialing Mistakes That Cost PCPs Money
- Incomplete or outdated CAQH profiles
- Expired licenses or malpractice policies
- Inconsistent practice addresses or tax IDs
- Seeing insured patients before credentialing is approved
👉 One missing document can delay credentialing for months. BillVolt helps practices avoid these costly oversights from day one.
What is Insurance Contracting?
Insurance contracting is the legal and financial agreement between your practice and the insurance payer.
Once credentialing is approved, the payer issues a contract that outlines:
- Reimbursement rates (fee schedules)
- Covered services and plans
- Billing rules and filing deadlines
- Payment timelines
- Termination and renewal clauses
- Compliance and credentialing requirements
Contracting answers a different but equally important question:
“How will this provider get paid, and under what terms?”
Why Contracting is so Critical for Providers Across All Specialties
Many healthcare practices sign contracts without fully reviewing them, eager to get in network and start seeing patients. Unfortunately, this can lead to:
• Below market reimbursement rates
• Unfavorable payment terms
• Limited or no renegotiation options
• Long-term revenue loss
A well-negotiated contract can significantly impact your bottom line over the life of the agreement.
Practical Contracting Tips for Primary Care
- Compare fee schedules to Medicare benchmarks
- Negotiate before signing, especially for high volume CPT codes
- Watch closely for auto-renewal and termination clauses
- Keep signed contracts organized and easily accessible
👉 Not sure if your contracts are competitive? BillVolt reviews payer contracts with primary care revenue in mind.
What is Insurance Paneling?
Insurance paneling is the final and often misunderstood step in the process.
Even if you are fully credentialed and have a signed contract, you are not considered in network until the payer completes paneling and activates you in their system. Paneling answers the last critical question:
“Is this provider officially active and visible to members as in network?”
What Happens During Paneling
- The provider and contract is loaded into the payer’s internal system
- In network effective dates are assigned
- The provider appears in payer directories
- Claims become eligible for in network reimbursement
Why Paneling Delays Are a Major Revenue Risk
Seeing patients before paneling is complete, results in:
- Out of network claim denials
- Reduced or zero reimbursement
- Patient balance disputes and complaints
👉 Never assume paneling is complete confirmation is essential. BillVolt verifies effective dates before billing begins.
Credentialing vs Contracting vs Paneling: A Simple Comparison
Process | Purpose | Applies To | Outcome |
Credentialing | Verify qualifications | Individual provider | Approved provider profile |
Contracting | Set payment terms | Practice & payer | Signed agreement |
Paneling | Activate in-network status | Provider & location | Claims paid in-network |
Think of it this way:
- Credentialing = Background check
- Contracting = Payment agreement
- Paneling = Go-live approval
How These Processes Work Together
For primary care providers or any specialty for that matter, the correct sequence is always:
- Complete credentialing
- Review and sign the payer contract
- Confirm paneling and effective dates
- Begin scheduling insured patients
- Submit claims with confidence
Skipping or rushing any step almost always leads to billing issues later.
👉 If your practice has ever asked, “Why wasn’t this paid?” the answer is actually hidden somewhere in this sequence.
Best Practices for Healthcare Providers
1. Start Early
Credentialing and paneling can take months. Begin 90–120 days before opening a new practice or adding a provider.
2. Track Everything
Maintain a detailed payer checklist that includes:
- Submission dates
- Follow up dates
- Approval confirmations or current status
- In network effective dates
- And the most recent follow up notes
3. Verify Before Billing
Never assume approval. Always confirm paneling and effective dates before submitting claims.
4. Consider Professional Help
Outsourcing credentialing and contracting can:
- Reduce delays
- Prevent denials
- Free up staff time
- Improve cash flow
How BillVolt Helps Providers of All Types
BillVolt Credentialing Specialists help individual providers and group practices manage the entire payer enrollment lifecycle, from credentialing and contracting to paneling and ongoing maintenance.
Our team supports practices by delivering:
- Faster approvals
- Proactive payer follow-ups
- Clean, accurate provider data
- Fewer denials and payment delays
Whether you are opening a new practice, adding providers, expanding payer participation, or cleaning up existing credentialing issues, we help you get it right the first time.
Ready to stop guessing and start getting paid?
Navigating the path from background checks to go-live approval shouldn’t be a gamble. Whether you’re adding a new provider or opening a second location, BillVolt ensures your paneling is active before the first claim is ever sent.