Provider credentialing is a process of assessing the qualifications of specific types of healthcare providers 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. It is a regulated process that is required by the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) . The process involves verifying a providers background information, skills, and competency levels. The following are the key steps involved in the provider credentialing process:

• Identify the required documents
• Prioritize insurance companies
• Check for accurate information
• Completing the application
• Conduct a background check
• Verify the providers information
• Follow up with the insurance company

The physician supplies the information required, including contact information, current CV, education and training history, licensing and certificates, medical group and hospital affiliations, Board certifications, sanctions or malpractice history, proof of liability insurance, and peer references. The health plan or provider organization checks that all the information is correct and up to date. If no problems are encountered, the provider organization or health plan awards a credential to the provider. The physician credentialing process can take as little as 30 days to complete up to as much as six months or more, particularly if the credentialing information is being reviewed by multiple health plans.