refers to the obtaining and reviewing the documentation of professional providers by a health plan. The documentation includes education, licensure, certifications, insurance, evidence of malpractice insurance and malpractice history.

The process of approving providers for membership in a network to provide services to consumers. This term can also refer to a peer competency-based credential similar to a license for professionals.

The process of reviewing a practitioner's academic, clinical and professional ability as demonstrated in the past to determine if criteria for clinical privileges are met.

A process of checking a practitioner's references and documenting his/her credentials, including training, experience demonstrated ability, licensure verification, malpractice insurance, etc. Credentialing is carried out by both hospitals and managed care organizations to ensure that only qualified practitioners with current, demonstrated competence have practice privileges at the hospital or other type health care facility, and that they practice within the range of their expertise and abilities.

Approving a provider to participate in a benefit plan.

A review process of potential medical providers to assess their standing and qualifications.

Examination of a physician's or other health care provider's credentials (i.e., proof that the applicant meets the requirements for education, training, licensure and professional standing) to determine whether they are eligible to contract with Health Plan Hawaii.

The process of determining eligibility for hospital or PHO of medical staff membership and privileges to be granted to physicians. Credentials and performance are periodically reviewed, which could result in a doctor's privileges being denied, modified, or withdrawn.

A managed-care plan's review of a physician's background and current professional standing, which is done before an HMO contracts with a doctor. The review usually requires evidence of graduation from an accredited medical school, a current state medical license, hospital privileges in good standing, and a professional liability claims history, including chemical dependency, felony convictions and disciplinary actions.

The review and verification process used to determine the current clinical competence of a provider and whether the provider meets the health plan’s or managed care company’s established criteria for participation in the network.

The process of validating the qualifications of a licensed independent practitioner to provide services in a health care network or its components; involves evaluating and verifying the individual's license, education, training, experience, and ability to perform the services requested.

Examination of a healthcare provider's qualifications to determine admittance into a participating provider network or receipt of clinical privileges at a hospital.

The process by which a hospital or other health care facility grants permission to health professionals to practice in the facility.  The process consists of a thorough investigation into the background of each individual including such things as education, licenses, prior practice, and prior disciplinary sanctions.  Once credentialed, an individual may continue to exercise his or her privileges until they are relinquished, revoked by the facility, or privileges are refused at recredentialing, which takes place at regular intervals.  In any proceeding to credential, recredential, or revoke privileges, the procedure must afford substantive and procedural due process.

(1) The process by which an organization or institution obtains, verifies, and assesses a pharmacist's qualifications to provide patient care services. (2) The process of granting a credential (a designation that indicates qualifications in a subject or an area.)

Examination of a physician's or other health care provider's credentials to determine whether he or she would be entitled to a contract with a carrier.

A process of obtaining, verifying, and assessing the qualifications of a health care practitioner to provide patient care services in or for a health care organization.

The review process of health care providers to examine the license, certification, evidence of malpractice insurance and history, and includes information given by the provider as well as by other organizations and individuals.

The process of reviewing a practitioners credentials, I.e. training, experience, or demonstrated ability, for the purpose of determining if criteria for clinical privileging are met.

"Managed care plan's review of a physician's background and current professional standing before contracting with him or her. This will usually require evidence of graduation from an accredited medical school, a current state medical license, hospital privileges in good standing, and a professional liability claims history, including chemical dependency, felony convictions and disciplinary actions. "

process of review to approve a provider who applies to participate in a health plan. Specific criteria and prerequisites are applied in determining initial and ongoing participation in the health plan.

A process that reviews a health care practitioner's credentials against the credentials required to participate in a network. To participate in our network, physicians, health care practitioners and facilities are credentialed before being admitted and are recredentialed every three years.

The process of checking a practitioner's qualifications to grant practice privileges for a facility or a health plan. The review may include references, training, experience, demonstrated ability, licensure verification, and adequate malpractice insurance. Practitioners have raised concerns that admission to managed care plans may also be based on economic profiling, which reviews their expenditures and may be used to exclude practitioners who serve populations with conditions that require expensive care.

The process of licensing, accrediting and certifying health care providers prior to allowing them to participate in a provider critical pathway. See clinical pathway.

is the recognition of professional or technical competence. The credentialing process may include certificationlicensureprofessional association membershipregistration or the award of an academic degree. Examples of credentials by certification include “R.T.(R)” indicating certification by the ARRT as a “registered technologist in radiography” “CNMT” indicating certification by the NMTCB as a “certified nuclear medicine technologist” and “RDMS” indicating certification by the ARDMS as a “registered diagnostic medical sonographer.” Credentials such as “CRT” indicate licensure by the state of California as a “ California radiologic technologist.” “FASRT” indicates a “Fellow of the American Society of Radiologic Technologists.” Academic credentials include “B.S.R.T.” “M.Ed.” and “Ph.D.

the privilege to perform, interpret, and seek professional reimbursement for nuclear cardiology services as determined at individual hospitals by the guidelines established by the Joint Commission on Accreditation of Hospitals (JCAHO). JCAHO does not determine the exact qualifications for specific privileges in nuclear cardiology, but rather that a mechanism be in place at each hospital for determining staff member privileges. Thus, each hospital establishes its own mechanism for assessing the qualifications of individual physicians and considerable variability exists between individual institutions.

Examination of a physician's or other health care provider's credentials to determine if he or she should be entitled to clinical privileges at a hospital or managed care organization.

The process of reviewing a practitioner's credentials--i.e., training, experience, or demonstrated ability--for the purpose of determining whether criteria for clinical privileges are met.

The process of obtaining, reviewing and verifying a provider's credentials - the documentation related to licenses, certifications, training and other qualifications - for the purpose of determining whether the provider meets the Managed Care Organization's preestablished criteria for participation in the network.

A systematic approach to assessing the qualifications of potential and existing providers through a review of relevant training, experience, licensure, certification, and/or registration to practice in a health care field; includes review of historical records to ascertain that potential providers have the required academic background and an acceptable record on issues relating to professional competence and conduct.

Process by which a potential or existing provider must meet certain standards in order to begin or continue participation in a health care plan or in a hospital medical staff organization. Credentialing helps determine the quality of personnel by providing standards for evaluating education, training, and competency.

This involves approving a provider based on certain criteria to provide or participate in a health plan. (H)

Credentialing is the administrative process for validating the qualifications of licensed professionals or organizations and assessing their background. Many health care institutions and provider networks conduct their own credentialing, generally through a credentialing specialist or electronic service, with review by a medical staff or credentialing committee. It may include granting and review of specific clinical privileges, and medical or allied health staff membership.