Credentialing, in plain language.

What credentialing is

Credentialing is how a facility confirms that a clinician is who they say they are, holds the licenses and certifications they claim, and has no disqualifying history. The standard is primary-source verification: a credential is confirmed with the body that issued it, not from a copy of a document you provide.

It exists because facilities are responsible for the clinicians who treat patients on site. Insurers, accreditors, and state regulators expect it.

The core checks

Credentialing draws on the same handful of sources wherever you work. Which ones apply depends on your role and the facility.

• State license boardsYour physician, NP, PA, CRNA, or RN license is confirmed with the board in each state where you'll work: status, expiration, and any disciplinary action. Most states don't license medical assistants, so their certification is reviewed instead.
• NPDB (National Practitioner Data Bank)A federal repository of malpractice payments and adverse actions on licenses, clinical privileges, and program participation. Hospitals are required to query it, and other eligible health care entities can.
• OIG and SAM exclusion listsFederal lists of people excluded from health care programs such as Medicare and Medicaid, or from federal contracting. Facilities that bill those programs screen against them.
• DEA registrationFor clinicians who prescribe controlled substances, the facility confirms a current DEA registration and any state controlled-substance registration. RNs and medical assistants don't hold DEA registrations.
• CertificationBoard or national certification is confirmed with the certifying body: ABMS or AOA boards for physicians, AANPCB or ANCC for NPs, NCCPA for PAs, NBCRNA for CRNAs, and the certifying organization for medical assistants.
• Education and trainingYour degree and training are confirmed with the institution. For physicians that includes residency and fellowship.
• Work history and referencesRecent work history, and references from people who've worked alongside you.

Credentialing vs. privileging

Credentialing answers 'is this clinician who they claim to be?' Privileging answers 'is this clinician approved to perform these specific procedures at this specific facility?'

Hospitals require both. Privileging adds medical staff committees, departmental review, and proctoring. Urgent care doesn't use hospital-style privileging, so those steps aren't part of the file.

Expirations and ongoing maintenance

Credentials expire on different cycles. Each state sets its own license renewal period, a practitioner's DEA registration renews on a three-year cycle, and certifying bodies set their own.

Facilities re-verify on their own schedule and again when a credential expires. A license that expires while a file is open holds the file until it's renewed.

What sets the pace

Checks against an online database, such as an exclusion list or the NPI registry, come back quickly. Anything that depends on a person answering, such as a former employer or a reference, takes as long as that person takes.

The slow items are the exceptions: a board that's slow to confirm a license, a former employer that doesn't return a reference request, or a malpractice carrier that's slow to send a loss-run report, which is its summary of claims against you.

How long a file takes depends on its slowest item. On Rediworks, the status of each item is shown in your dashboard.

What you can do to keep it moving

Three things are in your control.

• Upload complete documentsA scan that's cut off or out of date has to be replaced before the item can be reviewed.
• Warn your referencesTell your references a request is coming before it arrives. A reference who's expecting it is less likely to miss it.
• Check your expiration datesA license that expires partway through verification holds the file until it's renewed, so check your expiration dates before you start.