Medical Credentialing: Understanding How It Works, How Much It Costs, Etc.

Medical credentialing is a market-driven process that seeks to maintain standards of quality in the medical community for the benefit of patients. The process involves direct contact with primary sources for the verification of a healthcare provider’s qualifications. The credentialing authority, called a Credentials Verification Organization or CVO, will contact the university where the provider received their degree in medicine, had their training, and did their residency, to confirm their credentials.

They will also contact certification boards and licensing agencies to verify licenses and specialty certificates. Hospitals and other employers can provide confirmation of work history. Credentialing is important for all new hires, but it is performed at regular intervals even after hiring to conform to the standards of regulatory and accrediting organizations, like The Joint Commission (TJC), The Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA).

Credentialing is a term for a process that consists of two parts, credentialing and privileging. Credentialing is the verification of competency, as demonstrated by education, training, licensing and work experience. Privileging is the granting of approval for a healthcare provider to perform certain procedures based on the demonstration of competency.