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. 

MidlevelU 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.

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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Comments

Can a new Family Nurse Practitioner in KY applied for credentialing without being employed?

Margarita Nord