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What is Physician Healthcare Credentialing?

Mar 01, 2015 08:25PM ● By MED Magazine
By Lavonne McKee, Credentialing USA Inc. - Sioux Falls, SD


Healthcare credentialing has evolved over the years and plays an important role in protecting and providing healthcare services today.

Physician healthcare credentialing is a process where a healthcare professional proves that he/she is educated and capable of practicing his/her healthcare specialty.  The credentialing process is a lengthy process.  Every healthcare physician practicing in the United States will in some way be credentialed to practice. 

Credentialing may be done on many different levels including but not limited to the following: 

•             State medical license, residency and/or professional in every state practicing

•             Drug dispensing licenses on both national and in some states

•             Malpractice insurance

•             Health insurance companies

•             Healthcare facilities where practicing or holding privileges

•             Specialty committees in which participating

•             Federation of State Medical Boards

•             Federation Credentialing Verification Services

•             Medicare

•             Medicaid and others


The credentialing process varies for each healthcare professional.  Some of the variances are: type of professional, services provided and state where the service is provided.

The best way to find the requirements for a specific state is to refer to that specific state’s 

 medical licensing board.   A link to each state medical board may be found through the American Medical Association website at:  Some of the common variances include but are not limited to:  state drug license, continuing medical education hours, required residency licenses, foreign medical graduate requirements and others.

The purpose for credentialing is to protect the individual healthcare physician, patients, healthcare facilities and healthcare insurance companies.  The individual healthcare physician is protected by proving his/her competence in their healthcare specialty field.  The credentialing process includes obtaining malpractice insurance which provides protection for the physician and the patient.  When healthcare facilities follow their bylaws, policy and procedures created for the credentialing, they are protecting themselves by proving that their healthcare providers are educated and capable of practicing medicine.  This also gives the patients confidence in their healthcare services. Healthcare Insurance companies also credential individual healthcare providers to protect the insurance companies of fraudulent activities and to reimburse the healthcare provider according to his/her specialty, the services they provide and give the patients better services.

Credentialing healthcare professionals gives confidence to the entire healthcare community, the patients, physicians, other healthcare providers, healthcare facilities, and healthcare insurance companies.  As we work together, each doing our part in the healthcare credentialing arena, the healthcare community will continue to bring advanced healthcare and services to the public.