1.) The credentialing process for a behavioral health specialist (LCSW) vs a physician
2.) Or between a commercial payer vs straight Medicare or Medicaid. With either of these examples, you must be credentialed and contracted but the process or steps needed to accomplish this are very different.
With the first example, a psychiatrist may go through a national credentialing body like Psychcare which would handle the credentialing for multiple plans. The psychiatrist would still need to negotiate his/her contracts but it would be through a different division at the insurer such as United Behavioral Health instead of United Healthcare. On the other hand, a dermatologist would go through a local contracting representative that works specifically with this specialty rather than the whole state.
With the second example, the commercial insurer process involves credentialing (primary source verification, CAQH credentialing) and contracting which would include the contract negotiations; whereas with straight Medicaid or Medicare, they only need to be credentialed (Except where Participation vs Non Participation is concerned with Medicare). We are only speaking of straight Medicare and Medicaid, not the HMO plans which actually can be negotiated. Unfortunately, Medicare and Medicaid have established fee schedules which are non negotiable. With most of the commercial payers and HMOs, their fee schedule is set as a percentage of the current or prior year Medicare fee schedule. This is why cuts to Medicare are so impactful, even when a provider is not a Medicare provider. This is also why it is so vital to have an expert assist you in selecting evaluating your payer mix and negotiating your contracts.