PPO & networks / TERM EXPLAINED
Credentialing vs. Contracting
Credentialing verifies provider qualifications and enrollment criteria; contracting establishes commercial participation terms and rates.
A dental practice example
A newly acquired practice is credentialed but the new fee schedule is not yet effective.
Why it matters for reimbursement
An active credential alone does not establish participation or the correct reimbursable rate.
What to verify
Track both approval status and contract effective dates for each location.
FROM DEFINITION TO DECISION
Turn reimbursement questions into evidence.
PayorMap helps dental groups connect disclosed negotiated rates, provider and network context, and contract details to meaningful benchmarking questions. Coverage and mapping confidence vary by payor and market.