Group vs. Individual Credentialing: Who Needs What and When?
Understanding the credentialing structure your practice needs — and how to avoid costly delays.
Credentialing can feel confusing enough on its own, but for many practices, one question causes more frustration than anything else:
“Do we credential the provider individually, the group, or both?”
The answer matters. Choosing the wrong path can delay effective dates, interrupt reimbursement, and even prevent providers from billing entirely. This guide breaks down the difference between individual and group credentialing, when each is required, and how practices can streamline the process.
What Is Individual Credentialing?
Individual credentialing focuses on the provider — their license, training, education, background check, NPI, and eligibility to participate with an insurance payer.
An individual provider is credentialed as an Independent Professional with their own:
NPI Type 1
CAQH profile
Licensure & certifications
Liability insurance
Practice location(s) they will serve
Individual credentialing is required when:
A provider delivers services under their own name
A provider wants their own contract separate from a group
A provider is a sole proprietor without a group NPI
A payer requires individual enrollment regardless of group affiliation (common in Medicare, Medicaid, BCBS, and many commercial plans)
Even if a provider works under a group, most payers still want to verify the provider individually to ensure they meet all credentialing standards.
What Is Group (Organizational) Credentialing?
Group or organizational credentialing is for the practice entity and includes verifying:
Tax ID / EIN
NPI Type 2
Practice address
Ownership information
CLIA, business licenses, or facility documentation (if applicable)
W-9, voided check, or EFT/ERA information
Group liability coverage
This process creates a group contract or organizational agreement, allowing the practice to bill under the group NPI.
Group credentialing is required when:
The practice wants to bill under a group NPI
Providers will be linked (“affiliated”) to the group
A multi-provider practice wants in-network status as an entity
The payer issues group contracts separate from individual participation
Many payers will not allow a provider to bill under the group unless the group has an approved, active contract.
Do Providers Need Both?
In almost all cases: Yes — both the group and the individual must be credentialed.
Here’s how the structure works for most payers:
The group must be credentialed and contracted.
Each individual provider must be credentialed individually.
Each provider must be linked to the group contract.
Think of it like this:
The group contract approves the practice to bill as an organization.
The individual credentialing approves the provider to treat patients.
The linkage/affiliation authorizes the provider to bill within the group.
Failing to complete any one of the three steps will cause reimbursement delays.
Examples: When Providers Need One vs. Both
Scenario 1 — Solo Provider, No Employees, No NPI Type 2
Needs only individual credentialing unless they have a group NPI and want the practice credentialed.
Scenario 2 — Multi-Provider Medical or Behavioral Health Practice
Needs group credentialing (NPI 2)
Each provider needs individual credentialing (NPI 1)
Each must be linked to the group
Scenario 3 — Provider Contracting With Multiple Locations
Even if credentialed individually, they must be affiliated with:
Every group they work with
Every location the payer requires
Scenario 4 — Telehealth Providers
Telehealth providers are often credentialed individually, but if working under a telehealth organization:
The organization needs a group contract
The provider needs individual credentialing
The provider must be linked to the telehealth group
What Happens If You Skip One?
Missing a step can lead to:
Claim denials
Providers may be fully credentialed individually but not linked to the group, resulting in “Provider not associated with group” rejections.
Delayed reimbursement
If the group NPI isn’t contracted, the provider cannot bill services through the organization.
Retroactive payment issues
Some payers allow retroactive effective dates — others won’t. Missing paperwork can cost practices thousands.
Directory errors & audit red flags
Incorrect affiliations can cause payers to terminate contracts for noncompliance.
How to Streamline Group + Individual Credentialing
To avoid credentialing bottlenecks, practices should:
1. Credential the Group First
A group contract is often a prerequisite for linking providers.
2. Prepare All Provider Documents Early
Incomplete or outdated CAQH profiles are the #1 cause of delays.
3. Track Provider Onboarding Timelines
Most payers take 60–180 days to approve new providers.
4. Keep Demographics Updated
Even a missing suite number can cause affiliation delays.
5. Use a Professional Credentialing Partner
Final Thoughts
Individual vs. group credentialing is a critical part of getting providers in-network quickly and accurately. Understanding the structure — and setting up the right process from the start — prevents denials, delays, and lost income.
Honored Healthcare Systems specializes in managing both sides of the credentialing lifecycle, ensuring your providers and practice are approved, updated, and billing correctly.
Ready to simplify credentialing for your practice?
Whether you’re onboarding your first provider or expanding a large group, we can manage the entire credentialing and demographic maintenance process for you. Request a Credentialing & Onboarding Review today.
