What Nurse Practitioners Need to Know About Credentialing

When I was offered my first job in the emergency department, I assumed the transition would be smooth. After all, I was no longer a new graduate so my certification, licensure, and DEA number were all in order and ready for action. All I had to do was look over my contract and sign on the dotted line. I didn’t even bother to negotiate (while it worked out, I don’t recommend this!). But I was wrong. 

ThriveAP Intern Stephanie Bauer has used her administrative healthcare know-how to give us some insight into what nurse practitioners need to know about the NP credentialing process. Take it away Stephanie…

The Process of Getting Credentialed for Your Nurse Practitioner Job 

What does it mean to be credentialed as a healthcare provider? What about being certified? While the names are similar, the two are not the same thing. Healthcare certification is defined as official approval to do something legally or professionally. This is what you get when you pass your ‘boards’, or nurse practitioner certification exam. Credentialing is a system used by various organizations and agencies (think Medicare, Blue Cross) to ensure that their healthcare practitioners meet all necessary requirements and are appropriately qualified. Credentials are very specific to the type of provider and specialty.

The credentialing process involves the verification of education, licensure, certification, and reference checks. In order for a nurse practitioner or physician assistant to be eligile to bill government agencies and insurance companies, they must be credentialed.

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Initial credentialing involves a lot of paperwork. In most cases, a practice manager will help you sort through the process. If you are really lucky, they will simply flag the pages you need to sign. Typical credentialing items include forms outlining standardized procedures and protocols to be followed/performed by the provider, license verification, a copy of the DEA certificate, professional references, and more. Nurse practitioners (or their doting office managers) are responsible for gathering all the necessary materials and submitting them to each organization or agency.  

Once credentials are verified and a background check is complete, NPs are free to start working. Some hospitals or clinics may require nurse practitioners and physician assistants to complete a probationary period with chart review or other onboarding training looped in with the credentialing process as well.

When you start a new nurse practitioner position, be aware that a credentialing process is in order. It may take a month or two, or even more, to begin working. Having your licensure and other qualifications in order as well as completing necessary paperwork with care will help speed up the process and have your first paycheck on the way in a timely manner.


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7 thoughts on “What Nurse Practitioners Need to Know About Credentialing”

    1. I think it’s the other way around. You need to get credentialed before anyone will employ you. There may be some employers who do not require certification beyond licensure, but it seems rare.

  1. how would a Nurse Practitioner with an Active and Valid License but with lapsed credentials regain her ability to work again as a Nurse Practitioner?

    1. Credentialing is only part of the process for hospital providers. There is also privileging. You may also have to pay out of your own pocket for liability insurance, fingerprinting, background checks, repetitive education, and NPDB checks. Depending on the type of agency, such as a detention center for illegal immigrants which is federal, there could be post-credentialing/background check interrogations, which may include asking for you and your spouses tax returns and all W-2 and 1099 forms, even if you have a perfect credit, clear IRS record, or anything else for that matter. They just do that to do it I guess-required policy or process perhaps. Needless to say, you will feel harassed.

      For most jobs, count on three to six months before day one of work. Hope for an orientation if you’re lucky enough to get that. Make sure you have ample $ in a savings account to cover a year of waiting for income. I don’t think there is an insurance policy for the financial loss ensued form these processes, at least not yet.
      It is very different from the RN level which usually gets you onboard within a week or two.
      Also, all the certifications, renewals, required CEU, and if applicable, multi-state licensure related costs will add up to thousands of dollars. Lack of cooperating or educated HR generalists and credentialing departments can add delay times and road blocks. Private sector vs. government sector jobs also add different kinds of requirements and understanding ex. liability insurance vs. federal tort coverage for VHA providers. Ex. Private sector asks federal sector credentialing department for your claims history and coverage, and they don’t compute or cooperate in understanding the differences between federal tort and private policies. By the time they figure it all out, you have had to start work somewhere else to meet your overhead. Yes, there are silos along the way, and the burden is on you to connect everything. If you contract with multiple groups or sites, and therefore have to credential multiple times per year, you can imagine how fast you will burn out.
      Gone are the days of the $35 renewal every few years. It is advisable to sit with an accountant to figure out the most economical tax savings given your employment type and income. It can be a frustrating process. You will feel like you’re treated more like a criminal than a licensed medical professional or prescriber. And you thought that MS degree and certification would bring you some degree of respect and understanding for your abilities and competency? Think again.
      You need to be proactive on the front end so the right decision is made for your situation. Consulting with an HR attorney and nurse attorney can be helpful if the situation or need arises to understand your rights and responsibilities, and to recognize when violations occur. We need to collectively be reporting these experiences to appropriate bodies, or else we will continue to be the doormat profession.

      If you are discouraged by this, I suggest you write your federal and state representatives to ask for a maximum allowable time period for credentialing and privileging of health care providers such as the APP or MD, with stiff penalties and/or required compensation while the process is getting completed. When the delay is due to bureaucratic incompetency or lack of due diligence and education by those with power to prolong or delay your employment income without just cause, I would recommend consulting with an appropriate professional as previously mentioned. That might be the best way to motivate the industry to get things done efficiently.
      When providers jump through every hoop, are honest, law abiding, and highly professional qualified providers, they should receive treatment reflective of excellent business etiquette and respect. That is not the current industry standard, unfortunately.

  2. If I am already credentialed with my current employer but seeking a new job will my current job get a notification that I am being credentialed for another job with the new employer? I don’t want want to get caught in a crossfire! Lol

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