If you’re a healthcare provider or practice manager, you’ve probably heard the term credentialing, but do you know which type applies to your situation? From delayed reimbursements to provider onboarding snags, poor credentialing causes real headaches and costly revenue leakage.
In this post, we’ll break down the three essential types of medical credentialing, why each matters, and how you can avoid the most common (and expensive) pitfalls.
If you’re in the U.S. healthcare space and want faster reimbursements, cleaner claims, and better compliance, you’re in the right place.
What We’ll Cover
- What Is Credentialing in Healthcare?
- The 3 Main Types of Credentialing Explained
- When Do You Need Each Type?
- Common Mistakes and How to Avoid Them
What Is Credentialing in Healthcare?
Credentialing is the process of verifying that a healthcare provider is qualified to deliver care. It ensures they meet standards set by hospitals, insurers, and regulatory bodies.
Credentialing protects patients, helps maintain trust in the system, and is a non-negotiable requirement for billing insurance or joining provider networks.
Think of credentialing as the backbone of provider legitimacy and claim eligibility.
The 3 Main Types of Medical Credentialing
Understanding which type of credentialing you need can prevent delays and denials.
1. Provider Credentialing
- Confirms a clinician’s qualifications, licenses, and work history.
- Required when a new doctor joins a group or practice.
2. Payer Credentialing
- Involves enrolling providers with insurance companies.
- Without it, you can’t get reimbursed for insured patients.
3. Facility or Hospital Credentialing
- Required to gain admitting privileges at hospitals or outpatient centers.
- Often includes board certifications and malpractice history.
Tip: Most providers need all three at different stages of their career or practice growth.
When Do You Need Each Type?
- Starting a new job or joining a practice? You’ll need provider and payer credentialing.
- Switching insurance networks? Time to update payer credentialing.
- Expanding into hospitals or ASC affiliations? Facility credentialing is key.
Delays in these steps often lead to unpaid claims and operational chaos.
Common Mistakes and How to Avoid Them
- Submitting incomplete applications
- Not tracking expiration dates (DEA, licenses)
- Failing to follow up with payers or facilities
Simple tools like credentialing checklists, automated reminders, and third-party support can drastically reduce errors and turnaround time.
At MedVoice, we help practices reduce denials by up to 40% through streamlined, AI-powered credentialing workflows.
FAQ
How long does credentialing take?
Typically 60–90 days, depending on payer and application quality.
Do I need credentialing for telehealth?
Yes. Especially if crossing state lines or billing insurers.
Can I credential myself?
It’s possible, but errors and delays are common without support. Outsourcing ensures compliance and faster processing.
Why You Can Trust This Advice: Real-World Experience & Trusted Sources
At MedVoice, we’ve spent over 20 years helping clinics, physicians, medical practices, and hospitals navigate complex credentialing with ease. Our experts keep providers compliant and claims clean, without the overwhelm.
Sources:
Ready To Simplify Your Credentialing Process?
Credentialing might feel like a back-office task, but it’s one of the most critical steps in your revenue cycle. Understanding the three main types can mean the difference between smooth sailing and a pile of unpaid claims.
With MedVoice, you can turn credentialing into a strength, not a struggle.
Want to keep your credentials—and your revenue—on track?
Schedule a Credentialing Review — It’s free, fast, and no pressure.
Looking for a complete solution?
Explore Our Credentialing Services
Curious how credentialing ties into billing?
Read: “What’s the Real Cost of Bad Medical Billing?”
- Medical Credentialing 101: The 3 Types Every Healthcare Provider Must Know - June 14, 2025
- What Are the 3 Types of Medical Billing Systems? - May 29, 2025
- The Evolution of Revenue Cycle Management: Adapting to Modern Healthcare Needs - October 26, 2024
