🔍 What’s the Difference Between Credentialing & Contracting?
Many providers use these terms interchangeably—but they are two distinct (and equally critical) processes:
- Credentialing: This is the payer’s process of verifying your license, education, experience, liability insurance, and other qualifications.
- Contracting: Once credentialed, the payer issues a participation agreement that determines your rates, billing terms, and network status.
If either step is skipped or done incorrectly, you won’t get paid—or worse, you may unknowingly work out-of-network for months.
🧭 Our Credentialing Process Includes:
- CAQH profile creation or updates
- NPPES/NPI setup and alignment
- Medicaid and Medicare enrollment (including Colorado-specific HCPF systems)
- Roster additions for practice groups
- Credentialing with commercial payers like Aetna, Anthem/BCBS, Cigna/Evernorth, UnitedHealthcare/Optum, TriWest, and more
- Documentation collection and management (license, liability insurance, W-9, etc.)
We manage every step, track application status, follow up with payers, and troubleshoot delays so you don’t have to.
🤝 Contracting Services Include:
- Submission of participation requests to payers
- Negotiation of contract terms and fee schedules when applicable
- Review of contracts and rate sheets
- Assistance with “single case agreements” or non-par contracts
- Medicaid RAE network enrollment (Colorado Access, CCHA, RMHP, etc.)
- Group vs. individual NPI enrollment guidance
We also help ensure your contracts reflect your correct taxonomy codes, specialties, locations, and billing structure, so you don’t lose out on reimbursement due to setup errors.
📋 Therassistant Credentialing Roadmap
Here’s what to expect when you hire us to handle your credentialing and contracting:
Step 1: Onboarding & Intake We collect your license, resume, insurance, W-9, and other documentation through our secure portal.
Step 2: Profile & Application Set-Up We ensure your CAQH, NPPES, and Medicaid/Medicare records are accurate and linked properly to your practice or solo setup.
Step 3: Submit Payer Applications We submit credentialing and contracting applications to each target payer, tracking them weekly and following up as needed.
Step 4: Contract Execution Once credentialing is approved, we review and negotiate contracts when possible. We'll confirm your effective dates and fee schedules.
Step 5: Network Activation & Billing Readiness We confirm you're fully in-network and assist with EHR setup or billing system updates so you can begin billing with confidence.
⚖️ Colorado Medicaid Specialists
We specialize in Colorado’s Medicaid system and will ensure you’re:
- Properly enrolled as an Essential Safety Net Provider (Type 78)
- Added to the correct RAE networks based on your location
- Linked to both rendering and billing NPIs in InterChange and Gainwell
- Compliant with Medicaid documentation and billing expectations
✅ Why Work with Therassistant?
- We reduce credentialing time by up to 40% with consistent follow-up and streamlined systems
- We’ve helped over 100 Colorado clinicians get in-network with Medicaid and commercial payers
- We fix common mistakes that lead to denied claims, incorrect panel listings, or improper reimbursement
You’ll always know where you stand—we provide updates at every step