Credentialing is the process of assessing the qualifications of licensed medical professionals and assessing their background and legitimacy. It is a formal process that utilizes an established series of guidelines to ensure that patients receive the highest level of care from healthcare professionals who have undergone the most stringent scrutiny regarding their ability to practice medicine. Credentialing also assures the patient that they are being treated by providers whose qualifications, training, licensure, and ability to practice medicine are acceptable. The process includes verifying information such as education and training, residency, licenses, specialty certificates, qualifications, and career history.

The healthcare facility or managed care organization/health plan uses credentialing to collect and verify the “credentials” of the applicant. This includes verification of many elements including licensure, education, training, experience, competency, and judgment. Credentialing requires more comprehensive data of the professional, political member, or a group of professionals. There are three types of credentialing: personal credentialing, political credentialing, and paperless credentialing.

The process of credentialing has become more refined and thorough over the past 50 years. Today, several national agencies are dedicated to maintaining the credentialing process. Credentialing is a vital process for all healthcare institutions that must be performed to ensure that those healthcare workers who will be providing the clinical services are qualified to do so. Without medical credentialing, it can be extremely difficult to work with any healthcare software solutions.