Credentialing
Credentialing is the process a health plan or hospital uses to check a provider's qualifications, such as licenses, education, board certification, malpractice history and sanctions, before letting them join a network or practice, and again at set intervals.
What does credentialing check?
Whether the provider is who they say they are and is qualified and allowed to practice: active state licenses, DEA registration, education and training, board certification, work history, malpractice claims, and exclusions or sanctions.
How is credentialing different from directory data?
Credentialing asks whether a provider is qualified. Directory data asks where they practice now, how to reach them, and whether they take new patients. A fully credentialed provider can still have a wrong address and phone number in the directory.
Who does it?
Plans and hospitals, often with credentialing software or verification organizations. Monitoring for new sanctions between credentialing cycles is usually a separate service.