Taking good care of patients is only one part of running a successful healthcare practice. Behind the scenes, the business side needs to run just as smoothly to keep everything on track. That means getting paid on time, making sure providers are approved to see patients, and keeping the office running without unnecessary delays. Two important parts of this process are medical billing and credentialing.
At first glance, these might seem like totally separate jobs. Medical billing is about sending out claims and making sure insurance companies pay what they’re supposed to. Credentialing is about making sure healthcare providers are properly verified and approved by insurance networks and hospitals to see patients. But in reality, these two areas are closely connected.
If credentialing isn’t done correctly or on time, billing can’t even begin—because providers won’t be approved to deliver care under certain insurance plans. And if billing is delayed or done wrong, the practice might not get paid properly, even if everything else is in place. When one process breaks down, it creates a ripple effect that can lead to denied claims, lost revenue, and delays in patient care.
That’s why it’s so important to understand how medical billing and credentialing work together. When both run smoothly, your practice is in a much better position to care for patients and stay financially healthy.
Let’s break it down in simple terms.
What Credentialing Actually Does
Credentialing is the process that allows healthcare providers to work with insurance companies. It verifies that you meet all qualifications, licenses, and certifications to deliver care and get paid for it.
Without proper credentialing:
- You can’t accept patients from insurance networks
- Claims may be denied or go unpaid
- You could be out of compliance with payer or legal requirements
It’s not just paperwork—it’s what allows your services to be recognized and paid for within the healthcare system.
Why Medical Billing Is Just as Important
Once credentialing is complete, your practice can start billing insurance companies. But billing is more than sending out claims—if it’s not done right, you don’t get paid.
Common medical billing problems include:
- Using the wrong codes
- Missing claim submission deadlines
- Incorrect patient or insurance information’s
- Not following up on denied claims
A small mistake in billing can cause a long delay in payment—or lead to never getting paid at all.
To reduce those risks, many providers rely on professional medical billing services. Outsourcing to a billing partner means you get a team that understands payer rules, coding updates, and how to keep your revenue cycle moving.
How these Two Work Together
Here’s where many practices get stuck: credentialing and billing aren’t just separate departments—they’re deeply connected.
For example:
- You might be credentialed with an insurance company, but if your billing team uses the wrong provider ID or outdated information, the claim will be rejected.
- Your billing may be perfect, but if the provider hasn’t been properly enrolled in the payer’s network, the insurance company won’t pay.
That’s why many successful practices choose to handle both through the same trusted partner. Having billing and credentialing managed together improves accuracy and speeds up the entire revenue cycle.
What Smart Practices Are Doing
Here’s how leading practices handle credentialing and medical billing more efficiently:
🧩 They outsource both to experienced professionals
Trying to manage these processes in-house can lead to burnout and errors. Practices that work with specialized RCM teams save time and reduce claim denials.
🔄 They sync credentialing with their EHR
Connecting credentialing data to your EHR helps you catch insurance issues before the patient is even seen, making billing smoother from the start.
📅 They track re-credentialing timelines
Credentialing isn’t one-and-done. Providers must be re-credentialed periodically. Practices that stay ahead of those deadlines avoid disruptions in reimbursement. CMS guidelines explain how important it is to maintain updated enrollment status.
Final Thoughts
Credentialing and billing might not be the most exciting parts of healthcare—but they’re some of the most important.
Together, they help ensure:
- You’re visible to patients
- You can bill insurers correctly
- You get paid for the care you provide
- Your practice stays compliant and financially stable
If managing both is getting in the way of caring for your patients, it may be time to simplify things. Providers across the country are choosing outsourcing medical billing partners who help handle the entire process—from credentialing through claims—so they can focus on delivering care, not chasing payments.
