Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy.
Credentialing is the process of granting a designation, such as a certificate or license, by assessing an individual's knowledge, skill, or performance level.
Healthcare facilities and health plans will verify relevant education including medical school, residency/fellowship training, board certification, licensure, professional liability insurance and claims history, and will query the National Practitioner Data Bank (NPDB).
The NPDB is an electronic repository containing information on medical malpractice payments and certain adverse actions related to healthcare practitioners, entities, providers, and suppliers.
For example, hospitals will typically request information concerning procedures performed in order to document that the applicant is meeting current competency requirements for privileges requested, but health plans (insurance companies) do not typically collect this information because health plans do not grant privileges.
The provider must submit a credentialing application that details their training and qualifications to treat patients in their area of specialty.
This allows the parties to share information regarding credentialing decisions, as well as periodic updates of practitioner reviews and assessments.
A Credentials Committee[6] consisting of nine members is appointed at the beginning of each regular session of the General Assembly.