The Credentialing Process in Healthcare: Facility Guide
The credentialing process in healthcare follows a structured framework for verifying a provider’s background, licenses, and certifications to confirm they’re properly qualified to care for patients. This is a fundamental component of most onboarding protocols, typically done as soon as a clinician is hired. While it may be referred to as physician credentialing or medical credentialing, this verification process should be commenced for all types of allied healthcare professionals — including nurses and social workers — upon hire.
This systemwide approach is crucial for protecting patient safety, maintaining professional integrity, and meeting regulatory requirements. In this guide, we’ll outline three key steps to help facility leaders navigate the healthcare credentialing process. We’ll also answer some frequently asked questions to clarify verification-related details and provide a practical path forward for ensuring patient and organizational wellbeing.
What Is Credentialing’s Significance in Healthcare?
The provider credentialing process verifies that clinicians are qualified to deliver safe care, while helping to protect both organizations and patients from malpractice claims. Facilities participating in Centers for Medicare and Medicaid Services (CMS) programs are also federally mandated to complete the medical credentialing process for providers — and failing to do so can result in loss of funding. Even if your facility doesn’t participate in these programs, other professional organizations like the Joint Commission also mandate credentialing in their accreditation standards.
Many companies offer credentialing process flowcharts and other helpful resources to help ensure conditions of participation with CMS and other regulations are met. However you choose to pursue the credentialing process in healthcare, it’s an essential method for safeguarding your patients’ and organizational outcomes.
How to Credential a Provider: 3 Steps
With this understanding of credentialing in healthcare and its importance, you’re probably wondering how to best conduct the step-by-step credentialing process. While this will look slightly different from organization to organization, here are three fundamental steps that go into almost all professional provider credentialing processes.
1. Gather Information
The first step in the healthcare credentialing process is to gather essential information and supporting documents from your hired providers. This typically involves asking providers about their:
- Education and training.
- Employment/malpractice history.
- Licensure and certifications.
Some facilities may choose to hire third-party medical credentialing services that help gather this information. These companies, known as credential verification organizations (CVOs), can make the credentialing process more efficient.
Tip: Individual states may have specific requirements for how hospital credentialing processes must proceed. For example, Illinois requires all hospitals to collect information outlined in Section 965. Make sure that you double check your specific health department’s requirements. If you choose to collect any supplemental information, standardizing an online application will make the process easier for both you and your new hires.
2. Verify Information
After you gather the credentialing verifier information, you’ll need to authenticate it. Many facilities will correspond directly with the organizations that awarded the provider their credentials, such as educational institutions or licensing boards. However, you can also ask a CVO to carry out these verifications as well.
Tip: Verification shouldn’t end with the onboarding process. It’s important to continuously monitor a provider’s information to ensure that their credentials remain valid. Consider using a credentialing management platform that automatically notifies you when staff credentials expire or need to be re-checked.
3. Approve Employment
Approving employment is the last step in the credentialing process for providers. Once a facility receives and verifies a provider’s information, the department head usually meets with facility board members to do a final review of all documents. If there are no outstanding issues, they will go ahead and appoint the provider as staff.
Tip: Create a clinical or physician credentialing checklist that department heads and board members can use to review a provider’s information. This will ensure that all essential documents are accounted for, while helping to prevent errors.
The Credentialing Process in Healthcare: FAQ
Clinical and medical provider credentialing processes may vary by state and facility type. Below, we’ll answer some common questions associated with general qualification verification measures. However, it’s always best to refer to your specific department of health or clinical practitioner rules, especially when designing your healthcare credentialing policies.
What is checked during a credentialing process?
The credentialing process in healthcare can vary depending on the state and facility a provider is hired to work in. Here are some examples of the types of information that facilities should verify:
- Education, training, and board certification eligibility
- Continuing education credits
- Work and employment history
- Clinical privilege history
- Names and emails of professional references
- Clinical performance reviews
- Malpractice insurance carriers and claims history
- Explanations for any gaps in education, training, or work history
- Federal, state, and professional licenses and registrations
What do credentialing companies do for providers?
Third-party credentialing companies work with providers to help them gather all the information and documents needed to complete the credentialing process. They also help facilities comply with federal regulations and complete verification checks with schools and licensing boards.
What is a credentialing fee?
A credentialing fee includes all the costs associated with completing the qualification verification process. These fees are usually related to the time and resources needed to centralize applications, conduct background checks, and consult with educational/licensing boards.
Different types of credentialing in healthcare are associated with separate costs. For example, nurse licensure verification can cost as little as $30. Yet, the physician credentialing process for providers usually ranges between $100 and $200. These fees can also vary depending on how a facility’s credentialing system is set up and whether they’re using services from a CVO.
How long does the clinical credentialing process take?
Credentialing in healthcare can take weeks to months, depending on several different factors. The process can take longer if facilities don’t have an efficient system for gathering and reviewing information, or if a clinician or provider fails to send the required documents in a timely manner.
Hire Providers Who Make the Credentialing Process Easy
Now that you understand the significance of a staffwide credentialing process in healthcare, nursing and clinical leadership teams may be looking for hires to vet. Use our industry-leading job board to reach over 1 million highly qualified healthcare professionals today.