Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy. Many health care institutions and provider networks conduct their own credentialing, generally through a credentialing specialist or electronic service, with review by a credentialing committee. It may include granting and reviewing specific clinical privileges, and allied health staff membership.
Physicians and other healthcare practitioners who wish to bill an insurance company and receive reimbursement for services as an in-network provider must undergo a process of credentialing in which the insurance company verifies the provider's education, training, experience, and competency. Each provider must submit a credentialing application that details their training and qualifications to treat patients in their area of specialty. The insurance company then decides if the provider meets their internal qualifications to serve as a provider of services to their insured customers. After approval of a provider's credentials, the insurance company issues a participating provider contract that allows the provider of services to bill the insurance company and receive reimbursement as an in-network provider of services.
Personnel credentialing is typically undertaken at commencement of employment (initial application) and at regular intervals thereafter (reappointment). Credentialing of vendors or other organizations may begin prior to the purchasing process and be repeated regularly.
Political parties credential delegates at their conventions.
Paperless credentialing is the process of doing credentialing through a software package. With the internet, many web-based programs have been created to help automate the process of paperless credentialing.