Credentialing vs. Contracting: What’s the Difference—and Why It Matters
If you’re a midwife, own a freestanding birth center, or work as a doula or lactation consultant, understanding how to work with insurance companies can feel overwhelming—especially when it comes to credentialing and contracting. These two terms are often used interchangeably, but they’re not the same thing. Knowing the difference is critical for getting paid accurately, staying compliant, and helping your clients maximize their insurance benefits.
Credentialing: Verifying Your Qualifications
Credentialing is the process where insurance companies verify that you’re qualified to provide care. This includes reviewing:
Your license or certification
Education and training background
National Provider Identifier (NPI)
Malpractice insurance
Work history and references
Disciplinary actions, if any
For licensed midwives and lactation consultants, credentialing is a required first step to becoming recognized by an insurance payer. For doulas, credentialing may involve being recognized as a Traditional Health Worker (THW), community-based provider, or other classification depending on your state’s Medicaid program or private payer guidelines.
Why it matters:
If you’re not credentialed, you’re not eligible for reimbursement from most insurers—even if the plan covers your services.
Contracting: Defining the Relationship
Contracting is what happens after credentialing. This is where you enter into a formal agreement with the insurance company that spells out:
What services you’re allowed to bill for
What your reimbursement rates will be
How claims must be submitted
Any network participation terms
Without a contract, you might still be able to bill as an out-of-network provider, but that often means reduced or denied reimbursement—and higher out-of-pocket costs for your clients.
Why it matters:
Just because you’re credentialed doesn’t mean you’re in-network. You need a signed contract to access better reimbursement and offer full insurance benefits to the families you serve.
Common Pitfalls in the Midwifery and Birth Work Space
Assuming credentialing = contracting. Many midwives or birth centers think once they’re credentialed, they’re good to go. Unfortunately, not having a contract can result in denied claims.
Incomplete or outdated applications. Missing documentation can stall credentialing for months—delaying your ability to serve clients with insurance.
Confusion around doulas and lactation consultants. Some plans require specific codes, modifiers, or pathways (like THW certification) to approve contracts. Knowing these nuances is essential.
I Can Help You Get It Right
I specialize in credentialing and contracting for freestanding birth centers, licensed midwives, community-based doulas, and IBCLCs. I know the requirements, forms, payer quirks, and state-level regulations that affect your ability to get paid—and I’m here to make the process easier for you.
Whether you’re brand new and starting the process for the first time, or you’ve hit roadblocks with insurers like Medicaid, Providence, Moda, or Regence—I can guide you through it.
Work With Someone Who Understands Birth Work
I’m not just a billing and admin expert—I’m deeply passionate about supporting the birth community. I understand the unique care you provide and the challenges you face navigating an insurance system that often wasn’t built with you in mind.
Let me handle the paperwork, follow-ups, and payer communications so you can focus on what matters most: caring for families.
📩 Let’s Connect – Schedule a consultation and learn how I can support your practice.
📝 Already credentialed but not contracted? I’ll help you complete the next step.
🌿 New to billing and insurance? I’ll walk you through it, start to finish.