Who is who in credentialing
18 August 2026
The five parties and what runs between them. The person who provides the care is usually not the one who gets paid, and the patient is often not the subscriber. With a diagram.
Articles
Notes on credentialing and payer enrollment, written for the people who do this work. Claims about specific payer policies, regulations and statistics link to their sources, so you can check them rather than take our word for it. Payer policies change, and each article carries the date it was written.
Credentialing fundamentals
Three parts, written to be read in order. Start at the first if the words are new.
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Credentialing, enrollment, contracting and privileging are not the same thing
18 August 2026
Four words used as though they mean one thing. Each is a different piece of work, with a different organization, finishing on a different date — and the tidy sequence they are usually taught in is not how commercial payers do it.
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The credentialing terms that actually affect the work
18 August 2026
Effective dates, reassignment of benefits, revalidation as distinct from recredentialing, primary source verification, and the CAQH cycles. The terms that decide whether a claim is paid and when a clinician can start.
Behavioral health
Articles about the parts of this work that are particular to mental health and substance use care.
Being in a health plan's medical network may not put you in its behavioral health network
18 August 2026
Some health plans hand mental health benefits to a specialty company with its own network, its own credentialing and its own dates; others keep it in house. The name on the patient's card does not tell the credentialing team which it is.