Credentialing vs. Contracting: The Basics
When starting or growing a private practice, one of the most confusing steps is figuring out how to get on insurance panels. Terms like credentialing, contracting, group enrollment, and individual enrollment often get thrown around, and it can feel overwhelming.
The good news? Once you break down the differences, it all starts to make sense. Let’s dive into credentialing vs. contracting, and then explore whether it makes more sense to enroll as an individual provider or as a group practice.
What Is Credentialing?
Credentialing is the process insurance companies use to verify your qualifications as a provider. They review your:
Education and licensure
Training and certifications
Work history
Liability insurance
Background checks
Credentialing ensures that only qualified professionals can join a panel. Think of it as the “approval stage”—insurance companies confirming that you meet their requirements to provide care.
What Is Contracting?
Once credentialing is complete, the next step is contracting. This is where you enter into an agreement with the insurance company. The contract outlines:
Your reimbursement rates (how much you’ll be paid for services)
Billing procedures
Covered services
Compliance requirements
In short: credentialing gets you approved, contracting gets you paid.
Many providers mistakenly believe they’re “on the panel” as soon as they submit paperwork—but until you’ve signed a contract, you cannot bill or receive reimbursement.
Individual vs. Group Contracting
Beyond credentialing and contracting, another decision comes into play: should you enroll as an individual provider or as a group practice?
Individual Enrollment
Enrolling as an individual means:
Contracts are tied to you personally
You can still provide a business Tax ID and NPI for payment to a practice, or you can use your social security number and NPI 1
You can be associated with multiple practices under one contract, and the contract ports with you from practice to practice
If you bring on additional providers later, they must go through their own credentialing and contracting process separately, and are not guaranteed a contract
With some plans, this is the ONLY way to be contracted, until you have a quota of providers
Best for:
Solo practitioners just starting out
Practices that don’t plan to expand soon
Small groups who haven’t met the insurance requirement for a group contract
Group Enrollment
Contracting as a group means:
The business holds the contract, not the individual provider.
Providers are added to the group contract once they’re credentialed, often streamlining the process.
Adding providers is possible even if a panel is closed
Best for:
Practices planning to expand
Providers who want flexibility to add clinicians later
Practices that meet the minimum requirements (ex, Cigna requires 4 providers, OPTUM requires 6)
Credentialing and Contracting: Group vs. Individual
So how do these concepts work together?
If you credential and contract as an individual, your agreement is with you alone. Adding new providers later means starting the process over for each person.
If you credential and contract as a group, your practice holds the agreement. This makes scaling easier, because new clinicians can be added under the group umbrella once approved.
Both routes are valid—it depends on your vision for the practice, and the options with each insurance company.
Key Considerations Before Choosing
Your Business Goals
If you’re planning to stay solo, an individual contract may be simpler.
If you envision a multi-provider practice, group contracting sets you up for growth.
Billing Preferences
Regardless of Individual or Group Contract, if set up properly, payments go to the organization (and then are distributed internally).
Administrative Capacity
Group contracting involves more upfront setup but can save time in the long run.
Individual contracting is less complex initially but more work if you expand.
How TherAssist Can Help
Credentialing and contracting aren’t the same thing—credentialing gets you approved, and contracting gets you paid. From there, choosing between individual vs. group enrollment depends on your practice vision and the policies of each insurance plan.
The credentialing and contracting process can feel confusing, especially when you’re unsure whether to enroll as an individual or a group. At TherAssist, we simplify the process by:
Helping you decide which path aligns with your practice goals
Managing credentialing paperwork to avoid delays
Guiding you through contracting so you understand your reimbursement and compliance obligations
Setting up systems for smooth billing and long-term practice growth
Taking time to make the right choice now will save headaches later and set your business up for success. And if you’d like a partner to walk with you through the process, TherAssist is here to help.
