Credentialing: Frequently Asked Questions

Initial Application Questions | Privilege Form Questions
Reappointment Questions | Expirables Questions

General Questions

What is credentialing?

Credentialing is a term that usually encompasses two separate processes: credentialing and privileging.

  • Credentialing: Primary source verification of a health care practitioner’s education, training, work experience, license, etc.
  • Privileging: Granting approval for an individual to perform a specific procedure or specific set of procedures based on documented competence in the specialty in which privileges are requested.

Who is credentialed?

Practitioners who are independently responsible for patient care at HCMC by virtue of their license and hospital authority must be credentialed (regardless of whether they are HCMC employees or not). Credentialed providers at HCMC include:

    Credentialing Group in STAB Room Photo
  • Physicians
  • Dentists
  • Podiatrists
  • Chiropractors
  • Optometrists
  • Advanced Practice Nurses
  • Physician assistants
  • Psychologists
  • Acupuncturists
  • Advanced Dental Therapists
  • Pharmacists doing Medication Therapy Management
  • Radiology Practitioner Assistants

Why does HCMC credential?

HCMC, like other health care organizations, is legally responsible for knowing that individuals providing patient care are qualified and competent to do so. The Joint Commission, The Centers for Medicare and Medicaid Services (CMS), National Committee on Quality Assurance (NCQA), Minnesota Department of Health and Human Services and other oversight organizations require that members of the medical and allied health staff be credentialed and privileged before working in the facility.

Can a physician or other practitioner work before completing the credentialing process?

No. It is HCMC’s legal obligation to ensure that all practitioners have gone through the credentialing process and have been approved by the HHS Board of Directors to work at HCMC. A practitioner working at HCMC before the credentialing process is complete places the hospital and the practitioner at legal risk and can directly impact HCMC’s accreditation status.

What about medical students, residents and fellows?

Credentialing Two Residents, One Pregnant Photo

Any medical student, resident or fellow who is in an ACGME accredited training program affiliated with HCMC can work in the facility without being credentialed as long as their practice does not fall outside the scope of their current training program.

Physicians in training who wish to moonlight outside of their residency or fellowship program must be credentialed. For example, a Cardiology fellow who plans to moonlight as an internist must be credentialed for internal medicine privileges.

How do I know if I am currently credentialed with HCMC?

Contact HCMC Provider Credentialing Services at 612-873-9696 (option 5).

How does a practitioner get credentialed and request privileges at HCMC?

All requests for credentialing and privileging must be submitted through the appropriate department chief. Please contact the department service office for the department in which you wish to obtain privileges. If you do not have contact information for the department, you can call Provider Credentialing Services at 612-873-9696 (option 5) to request contact information.

Does HCMC require an application fee?

Initial applications require a fee of $250. Payment must be received by HCMC Provider Credentialing Services before the application is processed.

What is Primary Source Verification (PSV)?

Credentialing Nurse, Doc, Child Patient Photo
  • PSV is the process of verifying credentials directly with the source. For example, a credentialing office cannot accept a copy of a medical school degree as evidence that the physician graduated from medical school. The school must be contacted directly to verify the physician’s attendance and graduation.
  • PSV is required so that hospitals and credentialing offices do not receive fraudulent documents from applicants or other non-primary sources.
  • A credentialing office cannot accept any verification that comes through a third party rather than the primary source.
  • PSV is a requirement by accrediting bodies as well as the cornerstone of a good credentialing process.

What is The Joint Commission?

  • The Joint Commission is an accrediting organization with a mission to improve the safety and quality of care provided to the public.
  • Hospitals voluntarily submit to The Joint Commission accreditation surveys every three years; the survey is a comprehensive evaluation of the overall quality and safety of the organization.
  • HCMC Provider Credentialing Services complies with all of The Joint Commission credentialing standards.

Initial Application Questions

How far in advance of my start date should I begin the credentialing process?

Most health care organizations advise submitting an application 120 days before a practitioner’s start date. This lead time allows extra time when verification sources do not respond in a timely manner or clarification of discrepancies is required.

How long does it take a practitioner’s application to go through the credentialing process?

Credentialing Nurses Looking at Documentation Photo
  • The Credentialing process consists of two steps:
    1. Verification and evaluation processes performed by HCMC Provider Credentialing Services; and
    2. Review and approval of the verified application by the HCMC Medical Staff and the HHS Board of Directors
  • Offices that perform primary source verification of credentialing applications have very little control over process time. The process time is affected by outside verification sources (other hospitals, training programs, peer references, employers, etc.) responding to requests for information.
  • An application can be completed in less time if peer references and other verification sources promptly respond to HCMC’s requests for information, requested documentation is supplied by the applicant in a timely fashion and there are no red flags identified in the application process which require further investigation.
  • The verification process could be done in 2-3 weeks if all sources respond to first requests for information. If a response is not received, credentialing staff execute additional requests to sources; this causes a significant time delay in completing applications.
  • After the verification process is complete, it may take another month or more for the HCMC Medical Staff and the HHS Board of Directors to make their final decision about membership and privileges for the applicant.

Is there anything a practitioner can do to speed up the application process?

  • Yes. Practitioners can greatly influence the length of processing time by contacting their verification sources and asking each source to mail or fax HCMC’s verification requests back as soon as possible.
  • Practitioners can also help to speed the process by providing complete and accurate information on the application that they submit to Provider Credentialing Services.

What happens if the application submitted is incomplete or missing required attachments?

All incomplete applications are returned to the practitioner for completion; this creates a substantial delay in the practitioner credentialing process.

Privilege Form Questions

What are privilege forms?

    Credentialing Nurses Station, Female Resident Computer Photo
  • The Joint Commission accreditation standards require hospitals have privilege forms that indicate the type of care, treatment and services, or procedures that a practitioner will be authorized to perform.
  • Upon applying for initial appointment or reappointment, practitioners complete a privilege form indicating what privileges or procedures they want to perform at HCMC.
  • HCMC’s privilege forms include two types of privileges:
    1. Primary (or core) privileges are those privileges that are routinely taught in most residency programs for the particular specialty. Practitioners that meet the threshold criteria for the specialty are qualified to request core privileges
    2. Specialty Privilege Clusters are procedures that require additional training or special competence. Additional documentation is required to demonstrate competence.

How are privilege forms developed?

  • Physicians within each specialty help to develop the privilege forms, including privilege qualifications. For example, family medicine physicians review and make recommendations on the Family Medicine privilege form, cardiologists review and make recommendations on the Cardiovascular Disease form, etc.
  • At HCMC, the Credentials Committee then reviews the revisions proposed by physicians within the specialty and forwards recommendations to the Medical Executive Committee and the HHS Board of Directors. The Board of Directors has the final approval for all privilege forms at HCMC.

At reappointment, why do I have to submit documentation of cases performed when I have already been granted the privilege to perform the procedure?

  • The Joint Commission accreditation standards require that hospitals verify a practitioner’s current competency at each reappointment.
  • Documentation criteria on privilege forms are established by the medical staff.
  • If procedures were performed at HCMC, Provider Credentialing Services can obtain documentation on your behalf. Documentation of procedures performed at other institutions will need to be submitted by you along with your other reappointment paperwork.

Reappointment Questions

What is Reappointment?

  • HCMC has a duty to ensure that all practitioners on staff are currently competent; reappointment is the process by which the medical staff periodically re-evaluates provider competency.
  • The Joint Commission hospital accreditation standards require all practitioners to complete a reappointment process at least every 24 months.

What happens if I don’t complete my reappointment paperwork?

  • The Joint Commission accreditation standards require practitioners complete the reappointment process at least every 24 months; if a practitioner does not complete reappointment paperwork on time, the practitioner’s appointment and privileges will expire and they can no longer work or see patients at HCMC.
  • If a practitioner’s reappointment expires, the practitioner must complete the initial application process in order and be re-appointed to the medical or professional staff in order to treat patients at HCMC.

Expirables Questions

What are Expirables?

    Credentialing Staff Pushing Patient on Gurney Photo
  • “Expirables” are professional items with an expiration date that Provider Credentialing Services tracks and verifies on an on-going basis. At HCMC, Expirables include a practitioner's:
    • License to practice
    • Liability insurance
    • DEA registration
    • Board certification
  • Medical Staff Bylaws at HCMC require practitioners to maintain current Expirables at all times. Failure to renew Expirables may result in suspension of medical staff privileges at HCMC until renewal is verified by Provider Credentialing Services. All practitioners must be able to provide Provider Credentialing Services staff with renewed credentials or certificates PRIOR to expiration.

Why am I getting all these emails about my Expirables?

  • An expired license, DEA certificate, board certification, or liability certificate may cause suspension of your privileges—for your sake, and for the sake of HCMC’s patients, we don’t want that to happen. Because of this, we have our system programed to send you automated e-mail reminders for the following documents:
    • Licenses, DEAs: You will receive reminders starting at 30 days prior to the expiration date.
    • Physician Board Certifications: You will receive a yearly reminder of the importance of keeping up with your board's MOC requirements and deadlines
    • Non-Physician Certifications:  You will receive reminders starting at 60 days prior to the expiration date.
    • Liability Certificates: If you are not covered by HCMC’s Tort policy, you will receive an e-mail several weeks prior to the expiration of your insurance certificate.
  • The easiest way to reduce the number of e-mails you receive from credentialing is to renew your license, DEA, BLS, liability insurance and/or board certifications as soon as possible. Once credentialing can verify renewal, they will update your credentialing record.

What if I believe I received an email in error?

If you receive a reminder e-mail for an item you’ve recently completed and notified credentialing of, please disregard the e-mail; it is common for there to be a short processing time before your record is updated in the Credentialing office. However, if at any time you believe you are receiving an e-mail in error, please feel free to contact Provider Credentialing Services at 612-873-9696 (option 5); we would be happy to check your data for errors and/or explain the reason for the e-mail.